|
EUSTACHIAN TUBE BALLOON SYSTEM ACCLARENT AERA EU061655
|
Facility
|
IP
|
$11,334.00
|
|
|
Service Code
|
HCPCS C9745
|
| Hospital Charge Code |
5306666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,553.66 |
| Max. Negotiated Rate |
$10,427.28 |
| Rate for Payer: Aetna Commercial |
$10,200.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,747.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,007.02
|
| Rate for Payer: Cash Price |
$3,400.20
|
| Rate for Payer: Cigna Commercial |
$10,427.28
|
| Rate for Payer: Health EOS Commercial |
$10,087.26
|
| Rate for Payer: HFN Commercial |
$10,427.28
|
| Rate for Payer: Multiplan Commercial |
$9,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,800.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,427.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,553.66
|
| Rate for Payer: Quartz Commercial |
$6,800.40
|
| Rate for Payer: WEA Trust Commercial |
$6,233.70
|
| Rate for Payer: WPS Commercial |
$8,395.09
|
|
|
Evacuation of a subungual Hematoma
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
1190876
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$142.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.00
|
| Rate for Payer: Health EOS Commercial |
$136.50
|
| Rate for Payer: HFN Commercial |
$142.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.05
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$142.50
|
| Rate for Payer: Quartz Beloit One Network |
$66.00
|
| Rate for Payer: Quartz Commercial |
$85.50
|
| Rate for Payer: The Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.27
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
EVACUATOR UROVAC BLADDER 730125 M0067301250
|
Facility
|
OP
|
$510.00
|
|
| Hospital Charge Code |
5306820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Aetna Managed Medicare |
$142.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.40
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$331.50
|
| Rate for Payer: Quartz Medicare Advantage |
$306.00
|
| Rate for Payer: The Alliance Commercial |
$2,040.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
EVACUATOR UROVAC BLADDER 730125 M0067301250
|
Facility
|
IP
|
$510.00
|
|
| Hospital Charge Code |
5306820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$306.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Evaluation of Speech Fluency - SLP TH Evaluation Chg
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 95251 GN,95
|
| Hospital Charge Code |
5585356
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Aetna Managed Medicare |
$281.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.52
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$654.55
|
| Rate for Payer: Quartz Medicare Advantage |
$604.20
|
| Rate for Payer: The Alliance Commercial |
$4,028.00
|
| Rate for Payer: United Healthcare PPO |
$755.25
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Fluency - SLP TH Evaluation Chg
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 95251 GN,95
|
| Hospital Charge Code |
5585356
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$493.43 |
| Max. Negotiated Rate |
$926.44 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Fluency - Speech Language Evaluation
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
3978011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Aetna Managed Medicare |
$281.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.52
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$654.55
|
| Rate for Payer: Quartz Medicare Advantage |
$604.20
|
| Rate for Payer: The Alliance Commercial |
$4,028.00
|
| Rate for Payer: United Healthcare PPO |
$755.25
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Fluency - Speech Language Evaluation
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
3978011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$493.43 |
| Max. Negotiated Rate |
$926.44 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Sound Production - SLP TH Evaluation Chg
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 92522 GN,95
|
| Hospital Charge Code |
5585357
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$493.43 |
| Max. Negotiated Rate |
$926.44 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Sound Production - SLP TH Evaluation Chg
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 92522 GN,95
|
| Hospital Charge Code |
5585357
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Aetna Managed Medicare |
$281.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.52
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$654.55
|
| Rate for Payer: Quartz Medicare Advantage |
$604.20
|
| Rate for Payer: The Alliance Commercial |
$4,028.00
|
| Rate for Payer: United Healthcare PPO |
$755.25
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Sound Production - Speech Language Evaluation
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
3978010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$189.84 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$189.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| Rate for Payer: Quartz Medicare Advantage |
$406.80
|
| Rate for Payer: The Alliance Commercial |
$2,712.00
|
| Rate for Payer: United Healthcare PPO |
$508.50
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
Evaluation of Speech Sound Production - Speech Language Evaluation
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
3978010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$332.22 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$406.80
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
Evaluation of Speech Sound Production w/Language Comprehensi - SLP TH Evaluation Chg
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 92523 GN,95
|
| Hospital Charge Code |
5585358
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$493.43 |
| Max. Negotiated Rate |
$926.44 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Sound Production w/Language Comprehensi - SLP TH Evaluation Chg
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 92523 GN,95
|
| Hospital Charge Code |
5585358
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$4,028.00 |
| Rate for Payer: Aetna Commercial |
$906.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.02
|
| Rate for Payer: Aetna Managed Medicare |
$281.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.71
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$926.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.52
|
| Rate for Payer: Health EOS Commercial |
$896.23
|
| Rate for Payer: HFN Commercial |
$926.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: NAPHCARE Commercial |
$604.20
|
| Rate for Payer: Preferred Network Access Commercial |
$926.44
|
| Rate for Payer: Quartz Beloit One Network |
$493.43
|
| Rate for Payer: Quartz Commercial |
$654.55
|
| Rate for Payer: Quartz Medicare Advantage |
$604.20
|
| Rate for Payer: The Alliance Commercial |
$4,028.00
|
| Rate for Payer: United Healthcare PPO |
$755.25
|
| Rate for Payer: WEA Trust Commercial |
$553.85
|
| Rate for Payer: WPS Commercial |
$745.88
|
|
|
Evaluation of Speech Sound Production w/Language Comprehensi - Speech Language Evaluation
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
3978009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$423.85 |
| Max. Negotiated Rate |
$795.80 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.45
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$795.80
|
| Rate for Payer: Health EOS Commercial |
$769.85
|
| Rate for Payer: HFN Commercial |
$795.80
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: NAPHCARE Commercial |
$519.00
|
| Rate for Payer: Preferred Network Access Commercial |
$795.80
|
| Rate for Payer: Quartz Beloit One Network |
$423.85
|
| Rate for Payer: Quartz Commercial |
$519.00
|
| Rate for Payer: WEA Trust Commercial |
$475.75
|
| Rate for Payer: WPS Commercial |
$640.71
|
|
|
Evaluation of Speech Sound Production w/Language Comprehensi - Speech Language Evaluation
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 92523 GN
|
| Hospital Charge Code |
3978009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$3,460.00 |
| Rate for Payer: Aetna Commercial |
$778.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.90
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$458.45
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$795.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.05
|
| Rate for Payer: Health EOS Commercial |
$769.85
|
| Rate for Payer: HFN Commercial |
$795.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$692.00
|
| Rate for Payer: NAPHCARE Commercial |
$519.00
|
| Rate for Payer: Preferred Network Access Commercial |
$795.80
|
| Rate for Payer: Quartz Beloit One Network |
$423.85
|
| Rate for Payer: Quartz Commercial |
$562.25
|
| Rate for Payer: Quartz Medicare Advantage |
$519.00
|
| Rate for Payer: The Alliance Commercial |
$3,460.00
|
| Rate for Payer: United Healthcare PPO |
$648.75
|
| Rate for Payer: WEA Trust Commercial |
$475.75
|
| Rate for Payer: WPS Commercial |
$640.71
|
|
|
Evaluation of Wheezing 9406026
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
CPT 94060 26
|
| Hospital Charge Code |
3157503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$204.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$204.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.00
|
| Rate for Payer: Health EOS Commercial |
$195.65
|
| Rate for Payer: HFN Commercial |
$204.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.58
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Preferred Network Access Commercial |
$204.25
|
| Rate for Payer: Quartz Beloit One Network |
$94.60
|
| Rate for Payer: Quartz Commercial |
$122.55
|
| Rate for Payer: The Alliance Commercial |
$107.50
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
EVALUATION OF WHEEZING 9407026
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 94070 26
|
| Hospital Charge Code |
3015453
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.64 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.60
|
| Rate for Payer: Health EOS Commercial |
$96.46
|
| Rate for Payer: HFN Commercial |
$100.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.85
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Preferred Network Access Commercial |
$100.70
|
| Rate for Payer: Quartz Beloit One Network |
$46.64
|
| Rate for Payer: Quartz Commercial |
$60.42
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT 34704
|
Professional
|
Both
|
$14,653.00
|
|
|
Service Code
|
CPT 34704
|
| Hospital Charge Code |
6179665
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,708.17 |
| Max. Negotiated Rate |
$13,920.35 |
| Rate for Payer: Aetna Commercial |
$13,920.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,601.58
|
| Rate for Payer: Cash Price |
$4,395.90
|
| Rate for Payer: Cash Price |
$4,395.90
|
| Rate for Payer: Cigna Commercial |
$13,920.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,708.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,791.80
|
| Rate for Payer: Health EOS Commercial |
$13,334.23
|
| Rate for Payer: HFN Commercial |
$13,920.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,227.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,227.53
|
| Rate for Payer: Multiplan Commercial |
$11,722.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,920.35
|
| Rate for Payer: Quartz Beloit One Network |
$6,447.32
|
| Rate for Payer: Quartz Commercial |
$8,352.21
|
| Rate for Payer: The Alliance Commercial |
$7,326.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,708.17
|
| Rate for Payer: WEA Trust Commercial |
$8,059.15
|
| Rate for Payer: WPS Commercial |
$10,853.48
|
|
|
Evercross 10mm x 20mm 80cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Evercross 10mm x 20mm 80cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Evercross 10mm x 20mm 80cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Evercross 10mm x 40mm 80cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$751.52 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$1,622.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,622.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,024.80
|
| Rate for Payer: Health EOS Commercial |
$1,554.28
|
| Rate for Payer: HFN Commercial |
$1,622.60
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.60
|
| Rate for Payer: Quartz Beloit One Network |
$751.52
|
| Rate for Payer: Quartz Commercial |
$973.56
|
| Rate for Payer: The Alliance Commercial |
$854.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Evercross 10mm x 40mm 80cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Evercross 10mm x 40mm 80cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
