|
LASER FIBER MOSES 200 AC-10030100
|
Facility
|
OP
|
$4,456.25
|
|
| Hospital Charge Code |
6248126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.75 |
| Max. Negotiated Rate |
$17,825.00 |
| Rate for Payer: Aetna Commercial |
$4,010.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,832.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,896.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,228.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,139.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,361.81
|
| Rate for Payer: Cash Price |
$1,336.88
|
| Rate for Payer: Cigna Commercial |
$4,099.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,493.72
|
| Rate for Payer: Health EOS Commercial |
$3,966.06
|
| Rate for Payer: HFN Commercial |
$4,099.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,342.19
|
| Rate for Payer: Multiplan Commercial |
$3,565.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,673.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,099.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,183.56
|
| Rate for Payer: Quartz Commercial |
$2,896.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,673.75
|
| Rate for Payer: The Alliance Commercial |
$17,825.00
|
| Rate for Payer: WEA Trust Commercial |
$2,450.94
|
| Rate for Payer: WPS Commercial |
$3,300.74
|
|
|
LASER FIBER MOSES 365 AC-10030110
|
Facility
|
OP
|
$3,555.99
|
|
| Hospital Charge Code |
6248127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.68 |
| Max. Negotiated Rate |
$14,223.96 |
| Rate for Payer: Aetna Commercial |
$3,200.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,058.15
|
| Rate for Payer: Aetna Managed Medicare |
$995.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,311.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,706.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,884.67
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$3,271.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,989.93
|
| Rate for Payer: Health EOS Commercial |
$3,164.83
|
| Rate for Payer: HFN Commercial |
$3,271.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,666.99
|
| Rate for Payer: Multiplan Commercial |
$2,844.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,133.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,271.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.44
|
| Rate for Payer: Quartz Commercial |
$2,311.39
|
| Rate for Payer: Quartz Medicare Advantage |
$2,133.59
|
| Rate for Payer: The Alliance Commercial |
$14,223.96
|
| Rate for Payer: WEA Trust Commercial |
$1,955.79
|
| Rate for Payer: WPS Commercial |
$2,633.92
|
|
|
LASER FIBER MOSES 365 AC-10030110
|
Facility
|
IP
|
$3,555.99
|
|
| Hospital Charge Code |
6248127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,742.44 |
| Max. Negotiated Rate |
$3,271.51 |
| Rate for Payer: Aetna Commercial |
$3,200.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,058.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,884.67
|
| Rate for Payer: Cash Price |
$1,066.80
|
| Rate for Payer: Cigna Commercial |
$3,271.51
|
| Rate for Payer: Health EOS Commercial |
$3,164.83
|
| Rate for Payer: HFN Commercial |
$3,271.51
|
| Rate for Payer: Multiplan Commercial |
$2,844.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,133.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,271.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.44
|
| Rate for Payer: Quartz Commercial |
$2,133.59
|
| Rate for Payer: WEA Trust Commercial |
$1,955.79
|
| Rate for Payer: WPS Commercial |
$2,633.92
|
|
|
LASER FIBER MOSES 550 AC-10030120
|
Facility
|
IP
|
$3,612.15
|
|
| Hospital Charge Code |
6248128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,769.95 |
| Max. Negotiated Rate |
$3,323.18 |
| Rate for Payer: Aetna Commercial |
$3,250.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,106.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,914.44
|
| Rate for Payer: Cash Price |
$1,083.64
|
| Rate for Payer: Cigna Commercial |
$3,323.18
|
| Rate for Payer: Health EOS Commercial |
$3,214.81
|
| Rate for Payer: HFN Commercial |
$3,323.18
|
| Rate for Payer: Multiplan Commercial |
$2,889.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,167.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,323.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.95
|
| Rate for Payer: Quartz Commercial |
$2,167.29
|
| Rate for Payer: WEA Trust Commercial |
$1,986.68
|
| Rate for Payer: WPS Commercial |
$2,675.52
|
|
|
LASER FIBER MOSES 550 AC-10030120
|
Facility
|
OP
|
$3,612.15
|
|
| Hospital Charge Code |
6248128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.40 |
| Max. Negotiated Rate |
$14,448.60 |
| Rate for Payer: Aetna Commercial |
$3,250.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,106.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,011.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,347.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,806.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,733.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,914.44
|
| Rate for Payer: Cash Price |
$1,083.64
|
| Rate for Payer: Cigna Commercial |
$3,323.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,021.36
|
| Rate for Payer: Health EOS Commercial |
$3,214.81
|
| Rate for Payer: HFN Commercial |
$3,323.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,709.11
|
| Rate for Payer: Multiplan Commercial |
$2,889.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,167.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,323.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,769.95
|
| Rate for Payer: Quartz Commercial |
$2,347.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,167.29
|
| Rate for Payer: The Alliance Commercial |
$14,448.60
|
| Rate for Payer: WEA Trust Commercial |
$1,986.68
|
| Rate for Payer: WPS Commercial |
$2,675.52
|
|
|
LASER, LITHOTRIPSY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2950341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
LASER, LITHOTRIPSY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2950341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
LASER RESECTION, BLADDER NECK CONTRACTURE
|
Facility
|
IP
|
$7,915.00
|
|
| Hospital Charge Code |
2960191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,878.35 |
| Max. Negotiated Rate |
$7,281.80 |
| Rate for Payer: Aetna Commercial |
$7,123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,806.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,194.95
|
| Rate for Payer: Cash Price |
$2,374.50
|
| Rate for Payer: Cigna Commercial |
$7,281.80
|
| Rate for Payer: Health EOS Commercial |
$7,044.35
|
| Rate for Payer: HFN Commercial |
$7,281.80
|
| Rate for Payer: Multiplan Commercial |
$6,332.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,749.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,281.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,878.35
|
| Rate for Payer: Quartz Commercial |
$4,749.00
|
| Rate for Payer: WEA Trust Commercial |
$4,353.25
|
| Rate for Payer: WPS Commercial |
$5,862.64
|
|
|
LASER RESECTION, BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$7,915.00
|
|
| Hospital Charge Code |
2960191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,216.20 |
| Max. Negotiated Rate |
$31,660.00 |
| Rate for Payer: Aetna Commercial |
$7,123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,806.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,216.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,144.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,957.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,799.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,194.95
|
| Rate for Payer: Cash Price |
$2,374.50
|
| Rate for Payer: Cigna Commercial |
$7,281.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,429.23
|
| Rate for Payer: Health EOS Commercial |
$7,044.35
|
| Rate for Payer: HFN Commercial |
$7,281.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,936.25
|
| Rate for Payer: Multiplan Commercial |
$6,332.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,749.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,281.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,878.35
|
| Rate for Payer: Quartz Commercial |
$5,144.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,749.00
|
| Rate for Payer: The Alliance Commercial |
$31,660.00
|
| Rate for Payer: WEA Trust Commercial |
$4,353.25
|
| Rate for Payer: WPS Commercial |
$5,862.64
|
|
|
LASER RESECTION WITH DIODE LASER
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
5383077
|
|
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 RESECTION WITH DIODE LASER
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
5383077
|
|
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, STAPEDECTOMY
|
Facility
|
OP
|
$7,602.00
|
|
| Hospital Charge Code |
2960195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,128.56 |
| Max. Negotiated Rate |
$30,408.00 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,537.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,128.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,941.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,648.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,029.06
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$6,993.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,254.08
|
| Rate for Payer: Health EOS Commercial |
$6,765.78
|
| Rate for Payer: HFN Commercial |
$6,993.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,701.50
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,993.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,724.98
|
| Rate for Payer: Quartz Commercial |
$4,941.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,561.20
|
| Rate for Payer: The Alliance Commercial |
$30,408.00
|
| Rate for Payer: WEA Trust Commercial |
$4,181.10
|
| Rate for Payer: WPS Commercial |
$5,630.80
|
|
|
LASER, STAPEDECTOMY
|
Facility
|
IP
|
$7,602.00
|
|
| Hospital Charge Code |
2960195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,724.98 |
| Max. Negotiated Rate |
$6,993.84 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,537.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,029.06
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$6,993.84
|
| Rate for Payer: Health EOS Commercial |
$6,765.78
|
| Rate for Payer: HFN Commercial |
$6,993.84
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,993.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,724.98
|
| Rate for Payer: Quartz Commercial |
$4,561.20
|
| Rate for Payer: WEA Trust Commercial |
$4,181.10
|
| Rate for Payer: WPS Commercial |
$5,630.80
|
|
|
LASER, STONE MANIPULATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
LASER, STONE MANIPULATION
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
LASER SURGERY, EYE STRANDS 67031
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
CPT 67031
|
| Hospital Charge Code |
3015241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Aetna Commercial |
$1,587.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.06
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,587.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$505.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.60
|
| Rate for Payer: Health EOS Commercial |
$1,520.61
|
| Rate for Payer: HFN Commercial |
$1,587.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,196.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,196.14
|
| Rate for Payer: Multiplan Commercial |
$1,336.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.45
|
| Rate for Payer: Quartz Beloit One Network |
$735.24
|
| Rate for Payer: Quartz Commercial |
$952.47
|
| Rate for Payer: The Alliance Commercial |
$835.50
|
| Rate for Payer: United Healthcare Medicaid |
$505.37
|
| Rate for Payer: WEA Trust Commercial |
$919.05
|
| Rate for Payer: WPS Commercial |
$1,237.71
|
|
|
Laser Surgery Of Lens; YAG
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
CPT 66821
|
| Hospital Charge Code |
1188902
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.92 |
| Max. Negotiated Rate |
$1,061.15 |
| Rate for Payer: Aetna Commercial |
$1,061.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$960.62
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,061.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.20
|
| Rate for Payer: Health EOS Commercial |
$1,016.47
|
| Rate for Payer: HFN Commercial |
$1,061.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,052.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,052.29
|
| Rate for Payer: Multiplan Commercial |
$893.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.15
|
| Rate for Payer: Quartz Beloit One Network |
$491.48
|
| Rate for Payer: Quartz Commercial |
$636.69
|
| Rate for Payer: The Alliance Commercial |
$558.50
|
| Rate for Payer: United Healthcare Medicaid |
$256.92
|
| Rate for Payer: WEA Trust Commercial |
$614.35
|
| Rate for Payer: WPS Commercial |
$827.36
|
|
|
Laser Surgery of Lens; YAG 6682150
|
Professional
|
Both
|
$2,233.00
|
|
|
Service Code
|
CPT 66821 50
|
| Hospital Charge Code |
5510919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.92 |
| Max. Negotiated Rate |
$2,121.35 |
| Rate for Payer: Aetna Commercial |
$2,121.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,920.38
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cash Price |
$669.90
|
| Rate for Payer: Cigna Commercial |
$2,121.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.80
|
| Rate for Payer: Health EOS Commercial |
$2,032.03
|
| Rate for Payer: HFN Commercial |
$2,121.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,052.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,052.29
|
| Rate for Payer: Multiplan Commercial |
$1,786.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.35
|
| Rate for Payer: Quartz Beloit One Network |
$982.52
|
| Rate for Payer: Quartz Commercial |
$1,272.81
|
| Rate for Payer: The Alliance Commercial |
$1,116.50
|
| Rate for Payer: United Healthcare Medicaid |
$256.92
|
| Rate for Payer: WEA Trust Commercial |
$1,228.15
|
| Rate for Payer: WPS Commercial |
$1,653.98
|
|
|
LASER SURG, PENIS LESION(S) 54057
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
CPT 54057
|
| Hospital Charge Code |
3015019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Aetna Commercial |
$1,012.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,012.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.60
|
| Rate for Payer: Health EOS Commercial |
$970.06
|
| Rate for Payer: HFN Commercial |
$1,012.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.15
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.70
|
| Rate for Payer: Quartz Beloit One Network |
$469.04
|
| Rate for Payer: Quartz Commercial |
$607.62
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.59
|
|
|
LASER TX, SKIN 250-500 SQ CM 96921
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 96921
|
| Hospital Charge Code |
3015508
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.88 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.81
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: United Healthcare Medicaid |
$123.88
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
LASER TX, SKIN OVER 500 SQ CM 96922
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
CPT 96922
|
| Hospital Charge Code |
3015509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Aetna Commercial |
$421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$421.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.40
|
| Rate for Payer: Health EOS Commercial |
$404.04
|
| Rate for Payer: HFN Commercial |
$421.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.02
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$421.80
|
| Rate for Payer: Quartz Beloit One Network |
$195.36
|
| Rate for Payer: Quartz Commercial |
$253.08
|
| Rate for Payer: The Alliance Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicaid |
$184.48
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$328.87
|
|
|
LASER TX, SKIN UNDER 250 SQ CM 96920
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
CPT 96920
|
| Hospital Charge Code |
3015507
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.20
|
| Rate for Payer: Health EOS Commercial |
$256.62
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.06
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$124.08
|
| Rate for Payer: Quartz Commercial |
$160.74
|
| Rate for Payer: The Alliance Commercial |
$141.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.96
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
LASER, ZENKERS DIVERTICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960198
|
|
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, ZENKERS DIVERTICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960198
|
|
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
|
|
|
Lasix 20 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
2958933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
