|
Evercross 9mm x 80mm 135cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2548864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Evercross 9mm x 80mm 135cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2548864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Evercross 9mm x 80mm 135cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2548864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.58 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$888.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.79
|
| Rate for Payer: Health EOS Commercial |
$1,616.45
|
| Rate for Payer: HFN Commercial |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,687.50
|
| Rate for Payer: Quartz Beloit One Network |
$781.58
|
| Rate for Payer: Quartz Commercial |
$1,012.50
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Evercross 9mm x 80mm 80cm
|
Professional
|
Both
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.58 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Aetna Commercial |
$1,687.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,687.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$888.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.79
|
| Rate for Payer: Health EOS Commercial |
$1,616.45
|
| Rate for Payer: HFN Commercial |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,687.50
|
| Rate for Payer: Quartz Beloit One Network |
$781.58
|
| Rate for Payer: Quartz Commercial |
$1,012.50
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Evercross 9mm x 80mm 80cm
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Evercross 9mm x 80mm 80cm
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2547076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
EVERCROSS BALLOON 12MM X 20MM X80
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
EVERCROSS BALLOON 12MM X 20MM X80
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
EVERCROSS BALLOON 12MM X 40MM
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
EVERCROSS BALLOON 12MM X 40MM
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2972521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Everolimus Level
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3475536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.81 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna Commercial |
$225.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.84
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$230.59
|
| Rate for Payer: Health EOS Commercial |
$223.07
|
| Rate for Payer: HFN Commercial |
$230.59
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: Preferred Network Access Commercial |
$230.59
|
| Rate for Payer: Quartz Beloit One Network |
$122.81
|
| Rate for Payer: Quartz Commercial |
$150.38
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$185.64
|
|
|
Everolimus Level
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3475536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$238.11 |
| Rate for Payer: Aetna Commercial |
$238.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$238.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$228.08
|
| Rate for Payer: HFN Commercial |
$238.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$238.11
|
| Rate for Payer: Quartz Beloit One Network |
$110.28
|
| Rate for Payer: Quartz Commercial |
$142.86
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$56.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$62.83
|
|
|
Everolimus Level
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
3475536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna Commercial |
$225.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$230.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$223.07
|
| Rate for Payer: HFN Commercial |
$230.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$230.59
|
| Rate for Payer: Quartz Beloit One Network |
$122.81
|
| Rate for Payer: Quartz Commercial |
$162.92
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: United Healthcare PPO |
$187.98
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: Wellcare Medicare |
$14.28
|
| Rate for Payer: WPS Commercial |
$185.64
|
|
|
EVOKED AUDITORY TEST 9258726
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92587 26
|
| Hospital Charge Code |
3015342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$18.58
|
| Rate for Payer: Anthem Medicare Advantage |
$18.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.58
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.58
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.58
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.88
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.58
|
| Rate for Payer: The Alliance Commercial |
$46.46
|
| Rate for Payer: United Healthcare Medicaid |
$8.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.58
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$74.34
|
|
|
Evoked Otoacoustic Emissions; Comprehensive/Diagnostic Eval
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
1188813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.57 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.57
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$359.63
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
Evoked Otoacoustic Emissions; Comprehensive/Diagnostic Eval
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
1188813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$525.62 |
| Rate for Payer: Aetna Commercial |
$525.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Aetna Managed Medicare |
$33.97
|
| Rate for Payer: Anthem Medicare Advantage |
$33.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.97
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$525.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.97
|
| Rate for Payer: Health EOS Commercial |
$503.48
|
| Rate for Payer: HFN Commercial |
$525.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.97
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: NAPHCARE Commercial |
$50.95
|
| Rate for Payer: Preferred Network Access Commercial |
$525.62
|
| Rate for Payer: Quartz Beloit One Network |
$243.44
|
| Rate for Payer: Quartz Commercial |
$315.37
|
| Rate for Payer: Quartz Medicare Advantage |
$33.97
|
| Rate for Payer: The Alliance Commercial |
$84.92
|
| Rate for Payer: United Healthcare Medicaid |
$81.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.97
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$135.87
|
|
|
Evoked Otoacoustic Emissions; Comprehensive/Diagnostic Eval
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
1188813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$509.02 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
EXCALIBUR 4.0MM X 13CM ARTHROSCOPY ARTHREX AR-8400EX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5074914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM ARTHROSCOPY ARTHREX AR-8400EX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5074914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM CURVED ARTHROSCOPY ARTHREX AR-8400CEX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5074915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.0MM X 13CM CURVED ARTHROSCOPY ARTHREX AR-8400CEX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5074915
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 4.2MM X 19CM ARTHROSCOPY ARTHREX AR-6420EX
|
Facility
|
IP
|
$1,229.00
|
|
| Hospital Charge Code |
5074891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.30 |
| Max. Negotiated Rate |
$1,175.91 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.42
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cigna Commercial |
$1,175.91
|
| Rate for Payer: Health EOS Commercial |
$1,137.56
|
| Rate for Payer: HFN Commercial |
$1,175.91
|
| Rate for Payer: Multiplan Commercial |
$1,022.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.91
|
| Rate for Payer: Quartz Beloit One Network |
$626.30
|
| Rate for Payer: Quartz Commercial |
$766.90
|
| Rate for Payer: WEA Trust Commercial |
$702.99
|
| Rate for Payer: WPS Commercial |
$946.70
|
|
|
EXCALIBUR 4.2MM X 19CM ARTHROSCOPY ARTHREX AR-6420EX
|
Facility
|
OP
|
$1,229.00
|
|
| Hospital Charge Code |
5074891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,175.91 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,099.22
|
| Rate for Payer: Aetna Managed Medicare |
$357.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$830.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.42
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cigna Commercial |
$1,175.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.28
|
| Rate for Payer: Health EOS Commercial |
$1,137.56
|
| Rate for Payer: HFN Commercial |
$1,175.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.62
|
| Rate for Payer: Multiplan Commercial |
$1,022.53
|
| Rate for Payer: NAPHCARE Commercial |
$766.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.91
|
| Rate for Payer: Quartz Beloit One Network |
$626.30
|
| Rate for Payer: Quartz Commercial |
$830.80
|
| Rate for Payer: Quartz Medicare Advantage |
$766.90
|
| Rate for Payer: The Alliance Commercial |
$639.08
|
| Rate for Payer: WEA Trust Commercial |
$702.99
|
| Rate for Payer: WPS Commercial |
$946.70
|
|
|
EXCALIBUR 5.0MM ARTHROSCOPY ARTHREX AR-8500EX
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5206673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
EXCALIBUR 5.0MM ARTHROSCOPY ARTHREX AR-8500EX
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5206673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
