|
EXOSTECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
EXPANDER 450CC CONTOUR PROFILE
|
Facility
|
OP
|
$8,694.00
|
|
| Hospital Charge Code |
2965393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,434.32 |
| Max. Negotiated Rate |
$34,776.00 |
| Rate for Payer: Aetna Commercial |
$7,824.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,476.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,434.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,607.82
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: Cigna Commercial |
$7,998.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.16
|
| Rate for Payer: Health EOS Commercial |
$7,737.66
|
| Rate for Payer: HFN Commercial |
$7,998.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,520.50
|
| Rate for Payer: Multiplan Commercial |
$6,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,216.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,998.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.06
|
| Rate for Payer: Quartz Commercial |
$5,651.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,216.40
|
| Rate for Payer: The Alliance Commercial |
$34,776.00
|
| Rate for Payer: WEA Trust Commercial |
$4,781.70
|
| Rate for Payer: WPS Commercial |
$6,439.65
|
|
|
EXPANDER 450CC CONTOUR PROFILE
|
Facility
|
IP
|
$8,694.00
|
|
| Hospital Charge Code |
2965393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.06 |
| Max. Negotiated Rate |
$7,998.48 |
| Rate for Payer: Aetna Commercial |
$7,824.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,476.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,607.82
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: Cigna Commercial |
$7,998.48
|
| Rate for Payer: Health EOS Commercial |
$7,737.66
|
| Rate for Payer: HFN Commercial |
$7,998.48
|
| Rate for Payer: Multiplan Commercial |
$6,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,216.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,998.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.06
|
| Rate for Payer: Quartz Commercial |
$5,216.40
|
| Rate for Payer: WEA Trust Commercial |
$4,781.70
|
| Rate for Payer: WPS Commercial |
$6,439.65
|
|
|
EXPANULA WITH NO-SQUIRT CAP AR-6569
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
5767653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.40 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
EXPANULA WITH NO-SQUIRT CAP AR-6569
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
5767653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$3,440.00 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.60
|
| Rate for Payer: Aetna Managed Medicare |
$240.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.26
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.00
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$559.00
|
| Rate for Payer: Quartz Medicare Advantage |
$516.00
|
| Rate for Payer: The Alliance Commercial |
$3,440.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
Exparel (Bupivacaine Liposome) 20 ml (MED)
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4594739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$3,584.00 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Aetna Managed Medicare |
$250.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.40
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$537.60
|
| Rate for Payer: The Alliance Commercial |
$3,584.00
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
Exparel (Bupivacaine Liposome) 20 ml (MED)
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4594739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
EXPLORATION, MAXILLARY SINUS 31020
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
CPT 31020
|
| Hospital Charge Code |
3014368
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,320.54 |
| Rate for Payer: Aetna Commercial |
$632.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.76
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$632.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.60
|
| Rate for Payer: Health EOS Commercial |
$606.06
|
| Rate for Payer: HFN Commercial |
$632.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,320.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,320.54
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$632.70
|
| Rate for Payer: Quartz Beloit One Network |
$293.04
|
| Rate for Payer: Quartz Commercial |
$379.62
|
| Rate for Payer: The Alliance Commercial |
$333.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$366.30
|
| Rate for Payer: WPS Commercial |
$493.31
|
|
|
EXPLORATION, MAXILLARY SINUS 31030
|
Professional
|
Both
|
$2,810.00
|
|
|
Service Code
|
CPT 31030
|
| Hospital Charge Code |
3014369
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$753.31 |
| Max. Negotiated Rate |
$2,669.50 |
| Rate for Payer: Aetna Commercial |
$2,669.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.60
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,669.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$753.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.00
|
| Rate for Payer: Health EOS Commercial |
$2,557.10
|
| Rate for Payer: HFN Commercial |
$2,669.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,748.69
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.40
|
| Rate for Payer: Quartz Commercial |
$1,601.70
|
| Rate for Payer: The Alliance Commercial |
$1,405.00
|
| Rate for Payer: United Healthcare Medicaid |
$753.31
|
| Rate for Payer: WEA Trust Commercial |
$1,545.50
|
| Rate for Payer: WPS Commercial |
$2,081.37
|
|
|
EXPLORATION OF FOOT JOINT 28020
|
Professional
|
Both
|
$2,274.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
3014181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,160.30 |
| Rate for Payer: Aetna Commercial |
$2,160.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.64
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna Commercial |
$2,160.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.40
|
| Rate for Payer: Health EOS Commercial |
$2,069.34
|
| Rate for Payer: HFN Commercial |
$2,160.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,228.40
|
| Rate for Payer: Multiplan Commercial |
$1,819.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,160.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,000.56
|
| Rate for Payer: Quartz Commercial |
$1,296.18
|
| Rate for Payer: The Alliance Commercial |
$1,137.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,250.70
|
| Rate for Payer: WPS Commercial |
$1,684.35
|
|
|
EXPLORATION OF FOOT JOINT 28022
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
CPT 28022
|
| Hospital Charge Code |
3014182
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$1,097.58 |
| Rate for Payer: Aetna Commercial |
$1,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.28
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,090.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.80
|
| Rate for Payer: Health EOS Commercial |
$1,044.68
|
| Rate for Payer: HFN Commercial |
$1,090.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,097.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,097.58
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.60
|
| Rate for Payer: Quartz Beloit One Network |
$505.12
|
| Rate for Payer: Quartz Commercial |
$654.36
|
| Rate for Payer: The Alliance Commercial |
$574.00
|
| Rate for Payer: United Healthcare Medicaid |
$271.17
|
| Rate for Payer: WEA Trust Commercial |
$631.40
|
| Rate for Payer: WPS Commercial |
$850.32
|
|
|
EXPLORATION OF TOE JOINT 28024
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
3014183
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.86 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Aetna Commercial |
$1,061.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,061.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.20
|
| Rate for Payer: Health EOS Commercial |
$1,016.47
|
| Rate for Payer: HFN Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,024.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,024.94
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.15
|
| Rate for Payer: Quartz Beloit One Network |
$491.48
|
| Rate for Payer: Quartz Commercial |
$636.69
|
| Rate for Payer: The Alliance Commercial |
$558.50
|
| Rate for Payer: United Healthcare Medicaid |
$195.86
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
EXPLORE/IRRIGATE TEAR DUCTS 68840
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
CPT 68840
|
| Hospital Charge Code |
3015260
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Aetna Commercial |
$514.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$514.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.20
|
| Rate for Payer: Health EOS Commercial |
$493.22
|
| Rate for Payer: HFN Commercial |
$514.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.36
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: Preferred Network Access Commercial |
$514.90
|
| Rate for Payer: Quartz Beloit One Network |
$238.48
|
| Rate for Payer: Quartz Commercial |
$308.94
|
| Rate for Payer: The Alliance Commercial |
$271.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.84
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
EXPLORE WOUND, ABDOMEN 20102
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
3013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.63 |
| Max. Negotiated Rate |
$1,725.20 |
| Rate for Payer: Aetna Commercial |
$1,725.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,561.76
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$1,725.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,089.60
|
| Rate for Payer: Health EOS Commercial |
$1,652.56
|
| Rate for Payer: HFN Commercial |
$1,725.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.37
|
| Rate for Payer: Multiplan Commercial |
$1,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.20
|
| Rate for Payer: Quartz Beloit One Network |
$799.04
|
| Rate for Payer: Quartz Commercial |
$1,035.12
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: United Healthcare Medicaid |
$244.63
|
| Rate for Payer: WEA Trust Commercial |
$998.80
|
| Rate for Payer: WPS Commercial |
$1,345.11
|
|
|
EXPLORE WOUND, CHEST 20101
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 20101
|
| Hospital Charge Code |
3013701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.76 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.00
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: HFN Commercial |
$2,455.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$681.54
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: The Alliance Commercial |
$1,292.50
|
| Rate for Payer: United Healthcare Medicaid |
$199.76
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
EXPLORE WOUND, EXTREMITY 20103
|
Professional
|
Both
|
$2,392.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
3013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$329.12 |
| Max. Negotiated Rate |
$2,272.40 |
| Rate for Payer: Aetna Commercial |
$2,272.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,057.12
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,272.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$329.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,435.20
|
| Rate for Payer: Health EOS Commercial |
$2,176.72
|
| Rate for Payer: HFN Commercial |
$2,272.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,139.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,139.45
|
| Rate for Payer: Multiplan Commercial |
$1,913.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,272.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.48
|
| Rate for Payer: Quartz Commercial |
$1,363.44
|
| Rate for Payer: The Alliance Commercial |
$1,196.00
|
| Rate for Payer: United Healthcare Medicaid |
$329.12
|
| Rate for Payer: WEA Trust Commercial |
$1,315.60
|
| Rate for Payer: WPS Commercial |
$1,771.75
|
|
|
Export Aspiration 6Fr
|
Facility
|
OP
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.04 |
| Max. Negotiated Rate |
$23,072.00 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,615.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,749.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,884.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,768.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,227.77
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,326.00
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,749.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,460.80
|
| Rate for Payer: The Alliance Commercial |
$23,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Export Aspiration 6Fr
|
Professional
|
Both
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.92 |
| Max. Negotiated Rate |
$5,479.60 |
| Rate for Payer: Aetna Commercial |
$5,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,479.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,884.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,460.80
|
| Rate for Payer: Health EOS Commercial |
$5,248.88
|
| Rate for Payer: HFN Commercial |
$5,479.60
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,479.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.92
|
| Rate for Payer: Quartz Commercial |
$3,287.76
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Export Aspiration 6Fr
|
Facility
|
IP
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,826.32 |
| Max. Negotiated Rate |
$5,306.56 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,460.80
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Export Aspiration 7Fr
|
Facility
|
IP
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,826.32 |
| Max. Negotiated Rate |
$5,306.56 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,460.80
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Export Aspiration 7Fr
|
Professional
|
Both
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.92 |
| Max. Negotiated Rate |
$5,479.60 |
| Rate for Payer: Aetna Commercial |
$5,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,479.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,884.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,460.80
|
| Rate for Payer: Health EOS Commercial |
$5,248.88
|
| Rate for Payer: HFN Commercial |
$5,479.60
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,479.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.92
|
| Rate for Payer: Quartz Commercial |
$3,287.76
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Export Aspiration 7Fr
|
Facility
|
OP
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.04 |
| Max. Negotiated Rate |
$23,072.00 |
| Rate for Payer: Aetna Commercial |
$5,191.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,960.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,615.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,749.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,884.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,768.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,057.04
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,306.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,227.77
|
| Rate for Payer: Health EOS Commercial |
$5,133.52
|
| Rate for Payer: HFN Commercial |
$5,306.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,326.00
|
| Rate for Payer: Multiplan Commercial |
$4,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,306.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,826.32
|
| Rate for Payer: Quartz Commercial |
$3,749.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,460.80
|
| Rate for Payer: The Alliance Commercial |
$23,072.00
|
| Rate for Payer: WEA Trust Commercial |
$3,172.40
|
| Rate for Payer: WPS Commercial |
$4,272.36
|
|
|
Express Renal Stent
|
Facility
|
OP
|
$6,883.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4606631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.24 |
| Max. Negotiated Rate |
$27,532.00 |
| Rate for Payer: Aetna Commercial |
$6,194.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,919.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,927.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,473.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,303.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,647.99
|
| Rate for Payer: Cash Price |
$2,064.90
|
| Rate for Payer: Cigna Commercial |
$6,332.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,851.73
|
| Rate for Payer: Health EOS Commercial |
$6,125.87
|
| Rate for Payer: HFN Commercial |
$6,332.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,162.25
|
| Rate for Payer: Multiplan Commercial |
$5,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,129.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,332.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,372.67
|
| Rate for Payer: Quartz Commercial |
$4,473.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,129.80
|
| Rate for Payer: The Alliance Commercial |
$27,532.00
|
| Rate for Payer: WEA Trust Commercial |
$3,785.65
|
| Rate for Payer: WPS Commercial |
$5,098.24
|
|
|
Express Renal Stent
|
Facility
|
IP
|
$6,883.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4606631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,372.67 |
| Max. Negotiated Rate |
$6,332.36 |
| Rate for Payer: Aetna Commercial |
$6,194.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,919.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,647.99
|
| Rate for Payer: Cash Price |
$2,064.90
|
| Rate for Payer: Cigna Commercial |
$6,332.36
|
| Rate for Payer: Health EOS Commercial |
$6,125.87
|
| Rate for Payer: HFN Commercial |
$6,332.36
|
| Rate for Payer: Multiplan Commercial |
$5,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,129.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,332.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,372.67
|
| Rate for Payer: Quartz Commercial |
$4,129.80
|
| Rate for Payer: WEA Trust Commercial |
$3,785.65
|
| Rate for Payer: WPS Commercial |
$5,098.24
|
|
|
EXTENDER TIGHTROPE BUTTON AR-1589RT
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5415948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.32 |
| Max. Negotiated Rate |
$9,576.00 |
| Rate for Payer: Aetna Commercial |
$2,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.84
|
| Rate for Payer: Aetna Managed Medicare |
$670.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.82
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cigna Commercial |
$2,202.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.68
|
| Rate for Payer: Health EOS Commercial |
$2,130.66
|
| Rate for Payer: HFN Commercial |
$2,202.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.50
|
| Rate for Payer: Multiplan Commercial |
$1,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.06
|
| Rate for Payer: Quartz Commercial |
$1,556.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.40
|
| Rate for Payer: The Alliance Commercial |
$9,576.00
|
| Rate for Payer: WEA Trust Commercial |
$1,316.70
|
| Rate for Payer: WPS Commercial |
$1,773.24
|
|
