|
LAP, MOBIL SPLENIC FL ADD-ON 44213
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
CPT 44213
|
| Hospital Charge Code |
3014750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.57 |
| Max. Negotiated Rate |
$1,332.81 |
| Rate for Payer: Aetna Commercial |
$1,332.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,206.55
|
| Rate for Payer: Aetna Managed Medicare |
$153.57
|
| Rate for Payer: Anthem Medicare Advantage |
$153.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.57
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,332.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.57
|
| Rate for Payer: Health EOS Commercial |
$1,276.69
|
| Rate for Payer: HFN Commercial |
$1,332.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$630.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.57
|
| Rate for Payer: Multiplan Commercial |
$1,122.37
|
| Rate for Payer: NAPHCARE Commercial |
$230.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,332.81
|
| Rate for Payer: Quartz Beloit One Network |
$617.30
|
| Rate for Payer: Quartz Commercial |
$799.69
|
| Rate for Payer: Quartz Medicare Advantage |
$153.57
|
| Rate for Payer: The Alliance Commercial |
$652.66
|
| Rate for Payer: United Healthcare Medicaid |
$169.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.57
|
| Rate for Payer: WEA Trust Commercial |
$771.63
|
| Rate for Payer: WPS Commercial |
$691.05
|
|
|
LAPS COLECTOMY PRTLl W/RMVL TERMINAL ILEUM, ADDL 4420522
|
Professional
|
Both
|
$8,009.00
|
|
|
Service Code
|
CPT 44205 22
|
| Hospital Charge Code |
6171908
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$971.94 |
| Max. Negotiated Rate |
$7,912.89 |
| Rate for Payer: Aetna Commercial |
$7,912.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,163.25
|
| Rate for Payer: Cash Price |
$2,402.70
|
| Rate for Payer: Cash Price |
$2,402.70
|
| Rate for Payer: Cash Price |
$2,402.70
|
| Rate for Payer: Cigna Commercial |
$7,912.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$971.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,997.62
|
| Rate for Payer: Health EOS Commercial |
$7,579.72
|
| Rate for Payer: HFN Commercial |
$7,912.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,518.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,518.00
|
| Rate for Payer: Multiplan Commercial |
$6,663.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,912.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,664.92
|
| Rate for Payer: Quartz Commercial |
$4,747.74
|
| Rate for Payer: The Alliance Commercial |
$4,164.68
|
| Rate for Payer: United Healthcare Medicaid |
$971.94
|
| Rate for Payer: WEA Trust Commercial |
$4,581.15
|
| Rate for Payer: WPS Commercial |
$6,169.33
|
|
|
Laps Colectomy Prtl W/rmvl Terminal Ileum 44205
|
Professional
|
Both
|
$6,674.00
|
|
|
Service Code
|
CPT 44205
|
| Hospital Charge Code |
4624608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$971.94 |
| Max. Negotiated Rate |
$6,593.91 |
| Rate for Payer: Aetna Commercial |
$6,593.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,969.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,146.36
|
| Rate for Payer: Anthem Medicare Advantage |
$1,146.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,146.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,146.36
|
| Rate for Payer: Cash Price |
$2,002.20
|
| Rate for Payer: Cash Price |
$2,002.20
|
| Rate for Payer: Cash Price |
$2,002.20
|
| Rate for Payer: Cigna Commercial |
$6,593.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$971.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,146.36
|
| Rate for Payer: Health EOS Commercial |
$6,316.27
|
| Rate for Payer: HFN Commercial |
$6,593.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,518.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,518.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,146.36
|
| Rate for Payer: Multiplan Commercial |
$5,552.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,719.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,593.91
|
| Rate for Payer: Quartz Beloit One Network |
$3,054.02
|
| Rate for Payer: Quartz Commercial |
$3,956.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,146.36
|
| Rate for Payer: The Alliance Commercial |
$4,872.03
|
| Rate for Payer: United Healthcare Medicaid |
$971.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,146.36
|
| Rate for Payer: WEA Trust Commercial |
$3,817.53
|
| Rate for Payer: WPS Commercial |
$5,158.62
|
|
|
LAPS MOBLJ SPLENIC FLXR W/PRTL COLECTOMY- ADD-ON, ADDTL SVCS 4421322
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
CPT 44213 22
|
| Hospital Charge Code |
6174919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$1,598.58 |
| Rate for Payer: Aetna Commercial |
$1,598.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,447.14
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Cigna Commercial |
$1,598.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,009.63
|
| Rate for Payer: Health EOS Commercial |
$1,531.28
|
| Rate for Payer: HFN Commercial |
$1,598.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$630.16
|
| Rate for Payer: Multiplan Commercial |
$1,346.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.58
|
| Rate for Payer: Quartz Beloit One Network |
$740.40
|
| Rate for Payer: Quartz Commercial |
$959.15
|
| Rate for Payer: The Alliance Commercial |
$841.36
|
| Rate for Payer: United Healthcare Medicaid |
$169.89
|
| Rate for Payer: WEA Trust Commercial |
$925.50
|
| Rate for Payer: WPS Commercial |
$1,246.35
|
|
|
Large black foam
|
Facility
|
IP
|
$976.00
|
|
| Hospital Charge Code |
3006912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$933.84 |
| Rate for Payer: Aetna Commercial |
$913.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.97
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$933.84
|
| Rate for Payer: Health EOS Commercial |
$903.39
|
| Rate for Payer: HFN Commercial |
$933.84
|
| Rate for Payer: Multiplan Commercial |
$812.03
|
| Rate for Payer: Preferred Network Access Commercial |
$933.84
|
| Rate for Payer: Quartz Beloit One Network |
$497.37
|
| Rate for Payer: Quartz Commercial |
$609.02
|
| Rate for Payer: WEA Trust Commercial |
$558.27
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
Large black foam
|
Facility
|
OP
|
$976.00
|
|
| Hospital Charge Code |
3006912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$284.21 |
| Max. Negotiated Rate |
$933.84 |
| Rate for Payer: Aetna Commercial |
$913.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.93
|
| Rate for Payer: Aetna Managed Medicare |
$284.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$659.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$507.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.97
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$933.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.03
|
| Rate for Payer: Health EOS Commercial |
$903.39
|
| Rate for Payer: HFN Commercial |
$933.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$761.28
|
| Rate for Payer: Multiplan Commercial |
$812.03
|
| Rate for Payer: NAPHCARE Commercial |
$609.02
|
| Rate for Payer: Preferred Network Access Commercial |
$933.84
|
| Rate for Payer: Quartz Beloit One Network |
$497.37
|
| Rate for Payer: Quartz Commercial |
$659.78
|
| Rate for Payer: Quartz Medicare Advantage |
$609.02
|
| Rate for Payer: The Alliance Commercial |
$507.52
|
| Rate for Payer: WEA Trust Commercial |
$558.27
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
LARGE BORE EXTENSION SET 32 IN 4-WAY STOPCOCK SECURE LOCK
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2962797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
LARGE BORE EXTENSION SET 32 IN 4-WAY STOPCOCK SECURE LOCK
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2962797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
Large cannister and gel
|
Facility
|
OP
|
$684.00
|
|
| Hospital Charge Code |
3006907
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$199.18 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$199.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.09
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$533.52
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$426.82
|
| Rate for Payer: The Alliance Commercial |
$355.68
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
Large cannister and gel
|
Facility
|
IP
|
$684.00
|
|
| Hospital Charge Code |
3006907
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
Large white foam
|
Facility
|
IP
|
$244.00
|
|
| Hospital Charge Code |
3006910
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Large white foam
|
Facility
|
OP
|
$244.00
|
|
| Hospital Charge Code |
3006910
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$71.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.32
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$152.26
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$152.26
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Laryngeal Mask Airway Size 234
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
3101736
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
Laryngeal Mask Airway Size 234
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
3101736
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
LARYNGECTOMY
|
Facility
|
IP
|
$4,981.00
|
|
| Hospital Charge Code |
2960188
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,538.32 |
| Max. Negotiated Rate |
$4,765.82 |
| Rate for Payer: Aetna Commercial |
$4,662.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,745.53
|
| Rate for Payer: Cash Price |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$4,765.82
|
| Rate for Payer: Health EOS Commercial |
$4,610.41
|
| Rate for Payer: HFN Commercial |
$4,765.82
|
| Rate for Payer: Multiplan Commercial |
$4,144.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,765.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.32
|
| Rate for Payer: Quartz Commercial |
$3,108.14
|
| Rate for Payer: WEA Trust Commercial |
$2,849.13
|
| Rate for Payer: WPS Commercial |
$3,836.86
|
|
|
LARYNGECTOMY
|
Facility
|
OP
|
$4,981.00
|
|
| Hospital Charge Code |
2960188
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,450.47 |
| Max. Negotiated Rate |
$4,765.82 |
| Rate for Payer: Aetna Commercial |
$4,662.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,455.01
|
| Rate for Payer: Aetna Managed Medicare |
$1,450.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,367.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,590.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,486.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,745.53
|
| Rate for Payer: Cash Price |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$4,765.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,898.94
|
| Rate for Payer: Health EOS Commercial |
$4,610.41
|
| Rate for Payer: HFN Commercial |
$4,765.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,885.18
|
| Rate for Payer: Multiplan Commercial |
$4,144.19
|
| Rate for Payer: NAPHCARE Commercial |
$3,108.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,765.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,538.32
|
| Rate for Payer: Quartz Commercial |
$3,367.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,108.14
|
| Rate for Payer: The Alliance Commercial |
$2,590.12
|
| Rate for Payer: WEA Trust Commercial |
$2,849.13
|
| Rate for Payer: WPS Commercial |
$3,836.86
|
|
|
Laryngoscope Blade
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040313
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Laryngoscope Blade
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040313
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
LARYNGOSCOPE BLADE MCGRATH MAC SZ 3 350-005-000
|
Facility
|
IP
|
$318.00
|
|
| Hospital Charge Code |
6182696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$198.43
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
LARYNGOSCOPE BLADE MCGRATH MAC SZ 3 350-005-000
|
Facility
|
OP
|
$318.00
|
|
| Hospital Charge Code |
6182696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$92.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.08
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.04
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$198.43
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$214.97
|
| Rate for Payer: Quartz Medicare Advantage |
$198.43
|
| Rate for Payer: The Alliance Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
LARYNGOSCOPY
|
Facility
|
IP
|
$2,209.00
|
|
| Hospital Charge Code |
2960189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,125.71 |
| Max. Negotiated Rate |
$2,113.57 |
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,975.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.60
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,113.57
|
| Rate for Payer: Health EOS Commercial |
$2,044.65
|
| Rate for Payer: HFN Commercial |
$2,113.57
|
| Rate for Payer: Multiplan Commercial |
$1,837.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,113.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,125.71
|
| Rate for Payer: Quartz Commercial |
$1,378.42
|
| Rate for Payer: WEA Trust Commercial |
$1,263.55
|
| Rate for Payer: WPS Commercial |
$1,701.59
|
|
|
LARYNGOSCOPY
|
Facility
|
OP
|
$2,209.00
|
|
| Hospital Charge Code |
2960189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.26 |
| Max. Negotiated Rate |
$2,113.57 |
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,975.73
|
| Rate for Payer: Aetna Managed Medicare |
$643.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,148.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,102.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,217.60
|
| Rate for Payer: Cash Price |
$662.70
|
| Rate for Payer: Cigna Commercial |
$2,113.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,285.64
|
| Rate for Payer: Health EOS Commercial |
$2,044.65
|
| Rate for Payer: HFN Commercial |
$2,113.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.02
|
| Rate for Payer: Multiplan Commercial |
$1,837.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,378.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,113.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,125.71
|
| Rate for Payer: Quartz Commercial |
$1,493.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,378.42
|
| Rate for Payer: The Alliance Commercial |
$1,148.68
|
| Rate for Payer: WEA Trust Commercial |
$1,263.55
|
| Rate for Payer: WPS Commercial |
$1,701.59
|
|
|
Laryngoscopy, Diagnostic 31575
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
1152821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$59.30
|
| Rate for Payer: Anthem Medicare Advantage |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.30
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.30
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$88.95
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: Quartz Medicare Advantage |
$59.30
|
| Rate for Payer: The Alliance Commercial |
$252.03
|
| Rate for Payer: United Healthcare Medicaid |
$102.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.30
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$266.85
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
|
Facility
|
OP
|
$15,694.68
|
|
|
Service Code
|
CPT 31535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,923.67 |
| Max. Negotiated Rate |
$15,694.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$15,694.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$15,694.68
|
|
|
Service Code
|
CPT 31536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,923.67 |
| Max. Negotiated Rate |
$15,694.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$15,694.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
|
