|
DRAINAGE POUCH CLAMP CLOSURE 4 #18176"
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
2969906
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
DRAIN BL W/CATH INSERTION 51102
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
3014968
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$1,863.37 |
| Rate for Payer: Aetna Commercial |
$1,863.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.84
|
| Rate for Payer: Aetna Managed Medicare |
$121.85
|
| Rate for Payer: Anthem Medicare Advantage |
$121.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.85
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,863.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.85
|
| Rate for Payer: Health EOS Commercial |
$1,784.91
|
| Rate for Payer: HFN Commercial |
$1,863.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$504.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.85
|
| Rate for Payer: Multiplan Commercial |
$1,569.15
|
| Rate for Payer: NAPHCARE Commercial |
$182.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.37
|
| Rate for Payer: Quartz Beloit One Network |
$863.03
|
| Rate for Payer: Quartz Commercial |
$1,118.02
|
| Rate for Payer: Quartz Medicare Advantage |
$121.85
|
| Rate for Payer: The Alliance Commercial |
$517.85
|
| Rate for Payer: United Healthcare Medicaid |
$265.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.85
|
| Rate for Payer: WEA Trust Commercial |
$1,078.79
|
| Rate for Payer: WPS Commercial |
$548.31
|
|
|
Drain External Ear Lesion 6900050
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
CPT 69000 50
|
| Hospital Charge Code |
4498648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$919.83 |
| Rate for Payer: Aetna Commercial |
$919.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$919.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.94
|
| Rate for Payer: Health EOS Commercial |
$881.10
|
| Rate for Payer: HFN Commercial |
$919.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.73
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: Preferred Network Access Commercial |
$919.83
|
| Rate for Payer: Quartz Beloit One Network |
$426.03
|
| Rate for Payer: Quartz Commercial |
$551.90
|
| Rate for Payer: The Alliance Commercial |
$484.12
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
DRAIN FLAT SILICONE 7MM WIDE 0070430
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2963514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
DRAIN FLAT SILICONE 7MM WIDE 0070430
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2963514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Drain/Inject,Joint/Bursa 20600
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3426832
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$136.84 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$30.41
|
| Rate for Payer: Anthem Medicare Advantage |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.41
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.41
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.41
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$45.61
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$30.41
|
| Rate for Payer: The Alliance Commercial |
$129.24
|
| Rate for Payer: United Healthcare Medicaid |
$40.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.41
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$136.84
|
|
|
Drain/Inject,Joint/Bursa 2060050
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 20600 50
|
| Hospital Charge Code |
3311481
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.09
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.16
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: The Alliance Commercial |
$84.24
|
| Rate for Payer: United Healthcare Medicaid |
$40.28
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Drain/Inject,Joint/Bursa 20610
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5273163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$37.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.79
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.79
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.79
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$56.69
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$37.79
|
| Rate for Payer: The Alliance Commercial |
$160.62
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$170.07
|
|
|
Drain/Inject,Joint/Bursa 2061022
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 20610 22
|
| Hospital Charge Code |
4746606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$260.83 |
| Rate for Payer: Aetna Commercial |
$260.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$260.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.74
|
| Rate for Payer: Health EOS Commercial |
$249.85
|
| Rate for Payer: HFN Commercial |
$260.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: Preferred Network Access Commercial |
$260.83
|
| Rate for Payer: Quartz Beloit One Network |
$120.81
|
| Rate for Payer: Quartz Commercial |
$156.50
|
| Rate for Payer: The Alliance Commercial |
$137.28
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
Drain/Inject,Joint/Bursa 2061050
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
CPT 20610 50
|
| Hospital Charge Code |
3157515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$434.72 |
| Rate for Payer: Aetna Commercial |
$434.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$434.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.56
|
| Rate for Payer: Health EOS Commercial |
$416.42
|
| Rate for Payer: HFN Commercial |
$434.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$434.72
|
| Rate for Payer: Quartz Beloit One Network |
$201.34
|
| Rate for Payer: Quartz Commercial |
$260.83
|
| Rate for Payer: The Alliance Commercial |
$228.80
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
DRAIN IRRIGATION 3 7724
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2964067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
DRAIN IRRIGATION 3 7724
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2964067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
DRAIN LOWER LEG LESION 27603
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
CPT 27603
|
| Hospital Charge Code |
3014110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.11 |
| Max. Negotiated Rate |
$1,605.24 |
| Rate for Payer: Aetna Commercial |
$1,575.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,426.57
|
| Rate for Payer: Aetna Managed Medicare |
$356.72
|
| Rate for Payer: Anthem Medicare Advantage |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$356.72
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$1,575.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$356.72
|
| Rate for Payer: Health EOS Commercial |
$1,509.51
|
| Rate for Payer: HFN Commercial |
$1,575.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$356.72
|
| Rate for Payer: Multiplan Commercial |
$1,327.04
|
| Rate for Payer: NAPHCARE Commercial |
$535.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.86
|
| Rate for Payer: Quartz Beloit One Network |
$729.87
|
| Rate for Payer: Quartz Commercial |
$945.52
|
| Rate for Payer: Quartz Medicare Advantage |
$356.72
|
| Rate for Payer: The Alliance Commercial |
$1,516.06
|
| Rate for Payer: United Healthcare Medicaid |
$204.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$356.72
|
| Rate for Payer: WEA Trust Commercial |
$912.34
|
| Rate for Payer: WPS Commercial |
$1,605.24
|
|
|
Drain Lower Leg Lesion 2760350
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
CPT 27603 50
|
| Hospital Charge Code |
5360723
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.11 |
| Max. Negotiated Rate |
$3,151.72 |
| Rate for Payer: Aetna Commercial |
$3,151.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,853.14
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cash Price |
$957.00
|
| Rate for Payer: Cigna Commercial |
$3,151.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,990.56
|
| Rate for Payer: Health EOS Commercial |
$3,019.02
|
| Rate for Payer: HFN Commercial |
$3,151.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.04
|
| Rate for Payer: Multiplan Commercial |
$2,654.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,151.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,459.74
|
| Rate for Payer: Quartz Commercial |
$1,891.03
|
| Rate for Payer: The Alliance Commercial |
$1,658.80
|
| Rate for Payer: United Healthcare Medicaid |
$204.11
|
| Rate for Payer: WEA Trust Commercial |
$1,824.68
|
| Rate for Payer: WPS Commercial |
$2,457.26
|
|
|
DRAIN NECK/CHEST LESION 21501
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
3013735
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.99 |
| Max. Negotiated Rate |
$1,410.18 |
| Rate for Payer: Aetna Commercial |
$1,319.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.92
|
| Rate for Payer: Aetna Managed Medicare |
$313.37
|
| Rate for Payer: Anthem Medicare Advantage |
$313.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.37
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,319.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.37
|
| Rate for Payer: Health EOS Commercial |
$1,264.39
|
| Rate for Payer: HFN Commercial |
$1,319.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,133.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,133.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.37
|
| Rate for Payer: Multiplan Commercial |
$1,111.55
|
| Rate for Payer: NAPHCARE Commercial |
$470.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.97
|
| Rate for Payer: Quartz Beloit One Network |
$611.35
|
| Rate for Payer: Quartz Commercial |
$791.98
|
| Rate for Payer: Quartz Medicare Advantage |
$313.37
|
| Rate for Payer: The Alliance Commercial |
$1,331.83
|
| Rate for Payer: United Healthcare Medicaid |
$180.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.37
|
| Rate for Payer: WEA Trust Commercial |
$764.19
|
| Rate for Payer: WPS Commercial |
$1,410.18
|
|
|
DRAIN PELVIC ABSCESS, PERCUT 58823
|
Professional
|
Both
|
$4,796.00
|
|
| Hospital Charge Code |
3015142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,194.65 |
| Max. Negotiated Rate |
$4,738.45 |
| Rate for Payer: Aetna Commercial |
$4,738.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.54
|
| Rate for Payer: Cash Price |
$1,438.80
|
| Rate for Payer: Cigna Commercial |
$4,738.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,493.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.70
|
| Rate for Payer: Health EOS Commercial |
$4,538.93
|
| Rate for Payer: HFN Commercial |
$4,738.45
|
| Rate for Payer: Multiplan Commercial |
$3,990.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.65
|
| Rate for Payer: Quartz Commercial |
$2,843.07
|
| Rate for Payer: The Alliance Commercial |
$2,493.92
|
| Rate for Payer: WEA Trust Commercial |
$2,743.31
|
| Rate for Payer: WPS Commercial |
$3,694.36
|
|
|
DRAIN PENROSE 1/2 X 18 DYND50428/DYND50422"
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2963783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
DRAIN PENROSE 1/2 X 18 DYND50428/DYND50422"
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2963783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
DRAIN PENROSE 1/4x 18 DYND50427"
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2963366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
DRAIN PENROSE 1/4x 18 DYND50427"
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2963366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
DRAIN PENROSE 1 IN.X 36 IN.
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2963880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
DRAIN PENROSE 1 IN.X 36 IN.
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
2963880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
DRAIN ROUND SUCTION 1/8 (10FR) 0070310"
|
Facility
|
IP
|
$231.00
|
|
| Hospital Charge Code |
2963354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
