|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$15,694.68
|
|
|
Service Code
|
CPT 31541
|
|
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 |
$8,107.14
|
| 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 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 |
$715.35 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$968.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$745.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$715.35
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$968.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
|
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 |
$730.26 |
| Max. Negotiated Rate |
$1,371.09 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$894.19
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
|
LARYNGOSCOPY FOR ASPIRATION 31515
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
3014384
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.86 |
| Max. Negotiated Rate |
$650.10 |
| Rate for Payer: Aetna Commercial |
$650.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Aetna Managed Medicare |
$97.86
|
| Rate for Payer: Anthem Medicare Advantage |
$97.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.86
|
| 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 |
$650.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.86
|
| Rate for Payer: Health EOS Commercial |
$622.73
|
| Rate for Payer: HFN Commercial |
$650.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.86
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: NAPHCARE Commercial |
$146.80
|
| Rate for Payer: Preferred Network Access Commercial |
$650.10
|
| Rate for Payer: Quartz Beloit One Network |
$301.10
|
| Rate for Payer: Quartz Commercial |
$390.06
|
| Rate for Payer: Quartz Medicare Advantage |
$97.86
|
| Rate for Payer: The Alliance Commercial |
$415.92
|
| Rate for Payer: United Healthcare Medicaid |
$184.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.86
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$440.39
|
|
|
LARYNGOSCOPY, PEDIATRIC
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2950501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.19 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,279.82
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
LARYNGOSCOPY, PEDIATRIC
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2950501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Aetna Managed Medicare |
$597.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.68
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.78
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,386.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.82
|
| Rate for Payer: The Alliance Commercial |
$1,066.52
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
LASER ACCUTRAC 200 M0068404111
|
Facility
|
OP
|
$5,241.00
|
|
| Hospital Charge Code |
4594917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,526.18 |
| Max. Negotiated Rate |
$5,014.59 |
| Rate for Payer: Aetna Commercial |
$4,905.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,687.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,526.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,542.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,725.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,616.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,888.84
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cigna Commercial |
$5,014.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,050.26
|
| Rate for Payer: Health EOS Commercial |
$4,851.07
|
| Rate for Payer: HFN Commercial |
$5,014.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,087.98
|
| Rate for Payer: Multiplan Commercial |
$4,360.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,270.38
|
| Rate for Payer: Preferred Network Access Commercial |
$5,014.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,670.81
|
| Rate for Payer: Quartz Commercial |
$3,542.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,270.38
|
| Rate for Payer: The Alliance Commercial |
$2,725.32
|
| Rate for Payer: WEA Trust Commercial |
$2,997.85
|
| Rate for Payer: WPS Commercial |
$4,037.14
|
|
|
LASER ACCUTRAC 200 M0068404111
|
Facility
|
IP
|
$5,241.00
|
|
| Hospital Charge Code |
4594917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,670.81 |
| Max. Negotiated Rate |
$5,014.59 |
| Rate for Payer: Aetna Commercial |
$4,905.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,687.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,888.84
|
| Rate for Payer: Cash Price |
$1,572.30
|
| Rate for Payer: Cigna Commercial |
$5,014.59
|
| Rate for Payer: Health EOS Commercial |
$4,851.07
|
| Rate for Payer: HFN Commercial |
$5,014.59
|
| Rate for Payer: Multiplan Commercial |
$4,360.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,014.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,670.81
|
| Rate for Payer: Quartz Commercial |
$3,270.38
|
| Rate for Payer: WEA Trust Commercial |
$2,997.85
|
| Rate for Payer: WPS Commercial |
$4,037.14
|
|
|
LASER, CILIARY BODY DESTRUCTION
|
Facility
|
OP
|
$6,998.00
|
|
| Hospital Charge Code |
6175721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,037.82 |
| Max. Negotiated Rate |
$6,695.69 |
| Rate for Payer: Aetna Commercial |
$6,550.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,259.01
|
| Rate for Payer: Aetna Managed Medicare |
$2,037.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,730.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,638.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,493.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,857.30
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$6,695.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,072.84
|
| Rate for Payer: Health EOS Commercial |
$6,477.35
|
| Rate for Payer: HFN Commercial |
$6,695.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,458.44
|
| Rate for Payer: Multiplan Commercial |
$5,822.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,366.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,695.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,566.18
|
| Rate for Payer: Quartz Commercial |
$4,730.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,366.75
|
| Rate for Payer: The Alliance Commercial |
$3,638.96
|
| Rate for Payer: WEA Trust Commercial |
$4,002.86
|
| Rate for Payer: WPS Commercial |
$5,390.56
|
|
|
LASER, CILIARY BODY DESTRUCTION
|
Facility
|
IP
|
$6,998.00
|
|
| Hospital Charge Code |
6175721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,566.18 |
| Max. Negotiated Rate |
$6,695.69 |
| Rate for Payer: Aetna Commercial |
$6,550.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,259.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,857.30
|
| Rate for Payer: Cash Price |
$2,099.40
|
| Rate for Payer: Cigna Commercial |
$6,695.69
|
| Rate for Payer: Health EOS Commercial |
$6,477.35
|
| Rate for Payer: HFN Commercial |
$6,695.69
|
| Rate for Payer: Multiplan Commercial |
$5,822.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,695.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,566.18
|
| Rate for Payer: Quartz Commercial |
$4,366.75
|
| Rate for Payer: WEA Trust Commercial |
$4,002.86
|
| Rate for Payer: WPS Commercial |
$5,390.56
|
|
|
LASER, CO2 ORAL PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, CO2 ORAL PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, CO2 UROLOGY PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
6147662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, CO2 UROLOGY PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
6147662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, CRICOPHARYNGEUS MYOMECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, CRICOPHARYNGEUS MYOMECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, ENDOLUMENAL VENOUS WITH ULTRASOUND
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960197
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, ENDOLUMENAL VENOUS WITH ULTRASOUND
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960197
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LASER, ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$7,644.00
|
|
| Hospital Charge Code |
6222300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,225.93 |
| Max. Negotiated Rate |
$7,313.78 |
| Rate for Payer: Aetna Commercial |
$7,154.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,836.79
|
| Rate for Payer: Aetna Managed Medicare |
$2,225.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,167.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,974.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,815.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.37
|
| Rate for Payer: Cash Price |
$2,293.20
|
| Rate for Payer: Cigna Commercial |
$7,313.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,448.81
|
| Rate for Payer: Health EOS Commercial |
$7,075.29
|
| Rate for Payer: HFN Commercial |
$7,313.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,962.32
|
| Rate for Payer: Multiplan Commercial |
$6,359.81
|
| Rate for Payer: NAPHCARE Commercial |
$4,769.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,313.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.38
|
| Rate for Payer: Quartz Commercial |
$5,167.34
|
| Rate for Payer: Quartz Medicare Advantage |
$4,769.86
|
| Rate for Payer: The Alliance Commercial |
$3,974.88
|
| Rate for Payer: WEA Trust Commercial |
$4,372.37
|
| Rate for Payer: WPS Commercial |
$5,888.17
|
|
|
LASER, ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
IP
|
$7,644.00
|
|
| Hospital Charge Code |
6222300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,895.38 |
| Max. Negotiated Rate |
$7,313.78 |
| Rate for Payer: Aetna Commercial |
$7,154.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,836.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.37
|
| Rate for Payer: Cash Price |
$2,293.20
|
| Rate for Payer: Cigna Commercial |
$7,313.78
|
| Rate for Payer: Health EOS Commercial |
$7,075.29
|
| Rate for Payer: HFN Commercial |
$7,313.78
|
| Rate for Payer: Multiplan Commercial |
$6,359.81
|
| Rate for Payer: Preferred Network Access Commercial |
$7,313.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.38
|
| Rate for Payer: Quartz Commercial |
$4,769.86
|
| Rate for Payer: WEA Trust Commercial |
$4,372.37
|
| Rate for Payer: WPS Commercial |
$5,888.17
|
|
|
LASER EYE PROCEDURES
|
Facility
|
OP
|
$386.54
|
|
|
Service Code
|
EAPG 00232
|
| Min. Negotiated Rate |
$371.67 |
| Max. Negotiated Rate |
$386.54 |
| Rate for Payer: Anthem Medicaid |
$371.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$371.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.67
|
| Rate for Payer: Dean Health Medicaid |
$371.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$371.67
|
| Rate for Payer: Managed Health Services Medicaid |
$386.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$371.67
|
| Rate for Payer: United Healthcare Medicaid |
$371.67
|
|
|
LASER FIBER CO2 IMPERIAL 500 CO2-500 10988
|
Facility
|
OP
|
$5,778.00
|
|
| Hospital Charge Code |
6083641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,682.55 |
| Max. Negotiated Rate |
$5,528.39 |
| Rate for Payer: Aetna Commercial |
$5,408.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,682.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,905.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,004.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,884.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.83
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,528.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,362.80
|
| Rate for Payer: Health EOS Commercial |
$5,348.12
|
| Rate for Payer: HFN Commercial |
$5,528.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,506.84
|
| Rate for Payer: Multiplan Commercial |
$4,807.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,605.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.47
|
| Rate for Payer: Quartz Commercial |
$3,905.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,605.47
|
| Rate for Payer: The Alliance Commercial |
$3,004.56
|
| Rate for Payer: WEA Trust Commercial |
$3,305.02
|
| Rate for Payer: WPS Commercial |
$4,450.79
|
|
|
LASER FIBER CO2 IMPERIAL 500 CO2-500 10988
|
Facility
|
IP
|
$5,778.00
|
|
| Hospital Charge Code |
6083641
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,944.47 |
| Max. Negotiated Rate |
$5,528.39 |
| Rate for Payer: Aetna Commercial |
$5,408.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,167.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,184.83
|
| Rate for Payer: Cash Price |
$1,733.40
|
| Rate for Payer: Cigna Commercial |
$5,528.39
|
| Rate for Payer: Health EOS Commercial |
$5,348.12
|
| Rate for Payer: HFN Commercial |
$5,528.39
|
| Rate for Payer: Multiplan Commercial |
$4,807.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,528.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,944.47
|
| Rate for Payer: Quartz Commercial |
$3,605.47
|
| Rate for Payer: WEA Trust Commercial |
$3,305.02
|
| Rate for Payer: WPS Commercial |
$4,450.79
|
|
|
LASER FIBER FLEXIVA 550 MICRON M0068403930/M006L8405930
|
Facility
|
OP
|
$4,941.00
|
|
| Hospital Charge Code |
4595199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,438.82 |
| Max. Negotiated Rate |
$4,727.55 |
| Rate for Payer: Aetna Commercial |
$4,624.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,419.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,438.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,340.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,569.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,466.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,723.48
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cigna Commercial |
$4,727.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,875.66
|
| Rate for Payer: Health EOS Commercial |
$4,573.39
|
| Rate for Payer: HFN Commercial |
$4,727.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,853.98
|
| Rate for Payer: Multiplan Commercial |
$4,110.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,083.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,727.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.93
|
| Rate for Payer: Quartz Commercial |
$3,340.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,083.18
|
| Rate for Payer: The Alliance Commercial |
$2,569.32
|
| Rate for Payer: WEA Trust Commercial |
$2,826.25
|
| Rate for Payer: WPS Commercial |
$3,806.05
|
|
|
LASER FIBER FLEXIVA 550 MICRON M0068403930/M006L8405930
|
Facility
|
IP
|
$4,941.00
|
|
| Hospital Charge Code |
4595199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,517.93 |
| Max. Negotiated Rate |
$4,727.55 |
| Rate for Payer: Aetna Commercial |
$4,624.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,419.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,723.48
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cigna Commercial |
$4,727.55
|
| Rate for Payer: Health EOS Commercial |
$4,573.39
|
| Rate for Payer: HFN Commercial |
$4,727.55
|
| Rate for Payer: Multiplan Commercial |
$4,110.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,727.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,517.93
|
| Rate for Payer: Quartz Commercial |
$3,083.18
|
| Rate for Payer: WEA Trust Commercial |
$2,826.25
|
| Rate for Payer: WPS Commercial |
$3,806.05
|
|
