|
Laryngoscope Blade
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040313
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
LARYNGOSCOPE BLADE MCGRATH MAC SZ 3 350-005-000
|
Facility
|
IP
|
$318.00
|
|
| Hospital Charge Code |
6182696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.82 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.54
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| Rate for Payer: Health EOS Commercial |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$190.80
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$190.80
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
LARYNGOSCOPE BLADE MCGRATH MAC SZ 3 350-005-000
|
Facility
|
OP
|
$318.00
|
|
| Hospital Charge Code |
6182696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.04 |
| Max. Negotiated Rate |
$1,272.00 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Aetna Managed Medicare |
$89.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.54
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.95
|
| Rate for Payer: Health EOS Commercial |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$190.80
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$206.70
|
| Rate for Payer: Quartz Medicare Advantage |
$190.80
|
| Rate for Payer: The Alliance Commercial |
$1,272.00
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
LARYNGOSCOPY
|
Facility
|
OP
|
$2,209.00
|
|
| Hospital Charge Code |
2960189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$618.52 |
| Max. Negotiated Rate |
$8,836.00 |
| Rate for Payer: Aetna Commercial |
$1,988.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,899.74
|
| Rate for Payer: Aetna Managed Medicare |
$618.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,435.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,060.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,170.77
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,032.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,236.16
|
| Rate for Payer: Health EOS Commercial |
$1,966.01
|
| Rate for Payer: HFN Commercial |
$2,032.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,656.75
|
| Rate for Payer: Multiplan Commercial |
$1,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,325.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.41
|
| Rate for Payer: Quartz Commercial |
$1,435.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,325.40
|
| Rate for Payer: The Alliance Commercial |
$8,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,214.95
|
| Rate for Payer: WPS Commercial |
$1,636.21
|
|
|
LARYNGOSCOPY
|
Facility
|
IP
|
$2,209.00
|
|
| Hospital Charge Code |
2960189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,082.41 |
| Max. Negotiated Rate |
$2,032.28 |
| Rate for Payer: Aetna Commercial |
$1,988.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,899.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,170.77
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,032.28
|
| Rate for Payer: Health EOS Commercial |
$1,966.01
|
| Rate for Payer: HFN Commercial |
$2,032.28
|
| Rate for Payer: Multiplan Commercial |
$1,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,325.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,032.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.41
|
| Rate for Payer: Quartz Commercial |
$1,325.40
|
| Rate for Payer: WEA Trust Commercial |
$1,214.95
|
| Rate for Payer: WPS Commercial |
$1,636.21
|
|
|
Laryngoscopy, Diagnostic 31575
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
1152821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Aetna Commercial |
$386.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$386.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.20
|
| Rate for Payer: Health EOS Commercial |
$370.37
|
| Rate for Payer: HFN Commercial |
$386.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.47
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: Preferred Network Access Commercial |
$386.65
|
| Rate for Payer: Quartz Beloit One Network |
$179.08
|
| Rate for Payer: Quartz Commercial |
$231.99
|
| Rate for Payer: The Alliance Commercial |
$203.50
|
| Rate for Payer: United Healthcare Medicaid |
$98.80
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
|
Facility
|
OP
|
$14,805.68
|
|
|
Service Code
|
CPT 31535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$14,805.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$14,805.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$14,805.68
|
|
|
Service Code
|
CPT 31536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$14,805.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$14,805.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$14,805.68
|
|
|
Service Code
|
CPT 31541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$14,805.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$14,805.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
|
|
LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES) 31576
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
5983662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$687.84 |
| Max. Negotiated Rate |
$6,710.36 |
| Rate for Payer: Aetna Commercial |
$1,289.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,232.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$931.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$687.84
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$759.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,318.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$1,275.37
|
| Rate for Payer: HFN Commercial |
$1,318.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.36
|
| Rate for Payer: Quartz Beloit One Network |
$702.17
|
| Rate for Payer: Quartz Commercial |
$931.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$6,710.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: WEA Trust Commercial |
$788.15
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$1,061.42
|
|
|
LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES) 31576
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 31576
|
| Hospital Charge Code |
5983662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$702.17 |
| Max. Negotiated Rate |
$1,318.36 |
| Rate for Payer: Aetna Commercial |
$1,289.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,232.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$759.49
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,318.36
|
| Rate for Payer: Health EOS Commercial |
$1,275.37
|
| Rate for Payer: HFN Commercial |
$1,318.36
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$859.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.36
|
| Rate for Payer: Quartz Beloit One Network |
$702.17
|
| Rate for Payer: Quartz Commercial |
$859.80
|
| Rate for Payer: WEA Trust Commercial |
$788.15
|
| Rate for Payer: WPS Commercial |
$1,061.42
|
|
|
LARYNGOSCOPY FOR ASPIRATION 31515
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
3014384
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.93 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna Commercial |
$625.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$625.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.80
|
| Rate for Payer: Health EOS Commercial |
$598.78
|
| Rate for Payer: HFN Commercial |
$625.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.43
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: Preferred Network Access Commercial |
$625.10
|
| Rate for Payer: Quartz Beloit One Network |
$289.52
|
| Rate for Payer: Quartz Commercial |
$375.06
|
| Rate for Payer: The Alliance Commercial |
$329.00
|
| Rate for Payer: United Healthcare Medicaid |
$176.93
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
LARYNGOSCOPY, PEDIATRIC
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2950501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,004.99 |
| Max. Negotiated Rate |
$1,886.92 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,230.60
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
LARYNGOSCOPY, PEDIATRIC
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2950501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$8,204.00 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Aetna Managed Medicare |
$574.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.74
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.25
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.60
|
| Rate for Payer: The Alliance Commercial |
$8,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
LASER ACCUTRAC 200 M0068404111
|
Facility
|
OP
|
$5,241.00
|
|
| Hospital Charge Code |
4594917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,467.48 |
| Max. Negotiated Rate |
$20,964.00 |
| Rate for Payer: Aetna Commercial |
$4,716.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,467.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,406.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.73
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cigna Commercial |
$4,821.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,932.86
|
| Rate for Payer: Health EOS Commercial |
$4,664.49
|
| Rate for Payer: HFN Commercial |
$4,821.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,930.75
|
| Rate for Payer: Multiplan Commercial |
$4,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.09
|
| Rate for Payer: Quartz Commercial |
$3,406.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,144.60
|
| Rate for Payer: The Alliance Commercial |
$20,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,882.55
|
| Rate for Payer: WPS Commercial |
$3,882.01
|
|
|
LASER ACCUTRAC 200 M0068404111
|
Facility
|
IP
|
$5,241.00
|
|
| Hospital Charge Code |
4594917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,568.09 |
| Max. Negotiated Rate |
$4,821.72 |
| Rate for Payer: Aetna Commercial |
$4,716.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.73
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cigna Commercial |
$4,821.72
|
| Rate for Payer: Health EOS Commercial |
$4,664.49
|
| Rate for Payer: HFN Commercial |
$4,821.72
|
| Rate for Payer: Multiplan Commercial |
$4,192.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.09
|
| Rate for Payer: Quartz Commercial |
$3,144.60
|
| Rate for Payer: WEA Trust Commercial |
$2,882.55
|
| Rate for Payer: WPS Commercial |
$3,882.01
|
|
|
LASER, CILIARY BODY DESTRUCTION
|
Facility
|
IP
|
$6,998.00
|
|
| Hospital Charge Code |
6175721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,429.02 |
| Max. Negotiated Rate |
$6,438.16 |
| Rate for Payer: Aetna Commercial |
$6,298.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,708.94
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$6,438.16
|
| Rate for Payer: Health EOS Commercial |
$6,228.22
|
| Rate for Payer: HFN Commercial |
$6,438.16
|
| Rate for Payer: Multiplan Commercial |
$5,598.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,198.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.02
|
| Rate for Payer: Quartz Commercial |
$4,198.80
|
| Rate for Payer: WEA Trust Commercial |
$3,848.90
|
| Rate for Payer: WPS Commercial |
$5,183.42
|
|
|
LASER, CILIARY BODY DESTRUCTION
|
Facility
|
OP
|
$6,998.00
|
|
| Hospital Charge Code |
6175721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,959.44 |
| Max. Negotiated Rate |
$27,992.00 |
| Rate for Payer: Aetna Commercial |
$6,298.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,018.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,959.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,548.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,499.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,359.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,708.94
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$6,438.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,916.08
|
| Rate for Payer: Health EOS Commercial |
$6,228.22
|
| Rate for Payer: HFN Commercial |
$6,438.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,248.50
|
| Rate for Payer: Multiplan Commercial |
$5,598.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,198.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,438.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,429.02
|
| Rate for Payer: Quartz Commercial |
$4,548.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,198.80
|
| Rate for Payer: The Alliance Commercial |
$27,992.00
|
| Rate for Payer: WEA Trust Commercial |
$3,848.90
|
| Rate for Payer: WPS Commercial |
$5,183.42
|
|
|
LASER, CO2 ORAL PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, CO2 ORAL PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, CO2 UROLOGY PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
6147662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, CO2 UROLOGY PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
6147662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, CRICOPHARYNGEUS MYOMECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, CRICOPHARYNGEUS MYOMECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
LASER, ENDOLUMENAL VENOUS WITH ULTRASOUND
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960197
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
