|
LASER RESECTION, BLADDER NECK CONTRACTURE
|
Facility
|
IP
|
$7,915.00
|
|
| Hospital Charge Code |
2960191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,033.48 |
| Max. Negotiated Rate |
$7,573.07 |
| Rate for Payer: Aetna Commercial |
$7,408.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,079.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,362.75
|
| Rate for Payer: Cash Price |
$2,374.50
|
| Rate for Payer: Cigna Commercial |
$7,573.07
|
| Rate for Payer: Health EOS Commercial |
$7,326.12
|
| Rate for Payer: HFN Commercial |
$7,573.07
|
| Rate for Payer: Multiplan Commercial |
$6,585.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,573.07
|
| Rate for Payer: Quartz Beloit One Network |
$4,033.48
|
| Rate for Payer: Quartz Commercial |
$4,938.96
|
| Rate for Payer: WEA Trust Commercial |
$4,527.38
|
| Rate for Payer: WPS Commercial |
$6,096.92
|
|
|
LASER RESECTION, BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$7,915.00
|
|
| Hospital Charge Code |
2960191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,304.85 |
| Max. Negotiated Rate |
$7,573.07 |
| Rate for Payer: Aetna Commercial |
$7,408.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,079.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,304.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,350.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,115.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,951.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,362.75
|
| Rate for Payer: Cash Price |
$2,374.50
|
| Rate for Payer: Cigna Commercial |
$7,573.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,606.53
|
| Rate for Payer: Health EOS Commercial |
$7,326.12
|
| Rate for Payer: HFN Commercial |
$7,573.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,173.70
|
| Rate for Payer: Multiplan Commercial |
$6,585.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,938.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,573.07
|
| Rate for Payer: Quartz Beloit One Network |
$4,033.48
|
| Rate for Payer: Quartz Commercial |
$5,350.54
|
| Rate for Payer: Quartz Medicare Advantage |
$4,938.96
|
| Rate for Payer: The Alliance Commercial |
$4,115.80
|
| Rate for Payer: WEA Trust Commercial |
$4,527.38
|
| Rate for Payer: WPS Commercial |
$6,096.92
|
|
|
LASER RESECTION WITH DIODE LASER
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
5383077
|
|
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 RESECTION WITH DIODE LASER
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
5383077
|
|
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, STAPEDECTOMY
|
Facility
|
OP
|
$7,602.00
|
|
| Hospital Charge Code |
2960195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,213.70 |
| Max. Negotiated Rate |
$7,273.59 |
| Rate for Payer: Aetna Commercial |
$7,115.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,799.23
|
| Rate for Payer: Aetna Managed Medicare |
$2,213.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,138.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,953.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,794.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,190.22
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$7,273.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,424.36
|
| Rate for Payer: Health EOS Commercial |
$7,036.41
|
| Rate for Payer: HFN Commercial |
$7,273.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,929.56
|
| Rate for Payer: Multiplan Commercial |
$6,324.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,743.65
|
| Rate for Payer: Preferred Network Access Commercial |
$7,273.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,873.98
|
| Rate for Payer: Quartz Commercial |
$5,138.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,743.65
|
| Rate for Payer: The Alliance Commercial |
$3,953.04
|
| Rate for Payer: WEA Trust Commercial |
$4,348.34
|
| Rate for Payer: WPS Commercial |
$5,855.82
|
|
|
LASER, STAPEDECTOMY
|
Facility
|
IP
|
$7,602.00
|
|
| Hospital Charge Code |
2960195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,873.98 |
| Max. Negotiated Rate |
$7,273.59 |
| Rate for Payer: Aetna Commercial |
$7,115.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,799.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,190.22
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$7,273.59
|
| Rate for Payer: Health EOS Commercial |
$7,036.41
|
| Rate for Payer: HFN Commercial |
$7,273.59
|
| Rate for Payer: Multiplan Commercial |
$6,324.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,273.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,873.98
|
| Rate for Payer: Quartz Commercial |
$4,743.65
|
| Rate for Payer: WEA Trust Commercial |
$4,348.34
|
| Rate for Payer: WPS Commercial |
$5,855.82
|
|
|
LASER, STONE MANIPULATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
LASER, STONE MANIPULATION
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
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 |
$302.95 |
| Max. Negotiated Rate |
$1,650.95 |
| Rate for Payer: Aetna Commercial |
$1,650.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.54
|
| Rate for Payer: Aetna Managed Medicare |
$302.95
|
| Rate for Payer: Anthem Medicare Advantage |
$302.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$302.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$302.95
|
| 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 |
$1,650.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$525.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.95
|
| Rate for Payer: Health EOS Commercial |
$1,581.43
|
| Rate for Payer: HFN Commercial |
$1,650.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,243.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,243.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$302.95
|
| Rate for Payer: Multiplan Commercial |
$1,390.27
|
| Rate for Payer: NAPHCARE Commercial |
$454.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.95
|
| Rate for Payer: Quartz Beloit One Network |
$764.65
|
| Rate for Payer: Quartz Commercial |
$990.57
|
| Rate for Payer: Quartz Medicare Advantage |
$302.95
|
| Rate for Payer: The Alliance Commercial |
$1,287.55
|
| Rate for Payer: United Healthcare Medicaid |
$525.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.95
|
| Rate for Payer: WEA Trust Commercial |
$955.81
|
| Rate for Payer: WPS Commercial |
$1,363.28
|
|
|
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 |
$267.20 |
| Max. Negotiated Rate |
$1,230.42 |
| Rate for Payer: Aetna Commercial |
$1,103.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$273.43
|
| Rate for Payer: Anthem Medicare Advantage |
$273.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$273.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$273.43
|
| 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 |
$1,103.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.43
|
| Rate for Payer: Health EOS Commercial |
$1,057.13
|
| Rate for Payer: HFN Commercial |
$1,103.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,094.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$273.43
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$410.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.60
|
| Rate for Payer: Quartz Beloit One Network |
$511.14
|
| Rate for Payer: Quartz Commercial |
$662.16
|
| Rate for Payer: Quartz Medicare Advantage |
$273.43
|
| Rate for Payer: The Alliance Commercial |
$1,162.06
|
| Rate for Payer: United Healthcare Medicaid |
$267.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.43
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$1,230.42
|
|
|
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 |
$267.20 |
| Max. Negotiated Rate |
$2,206.20 |
| Rate for Payer: Aetna Commercial |
$2,206.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,997.20
|
| 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 |
$2,206.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,393.39
|
| Rate for Payer: Health EOS Commercial |
$2,113.31
|
| Rate for Payer: HFN Commercial |
$2,206.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,094.38
|
| Rate for Payer: Multiplan Commercial |
$1,857.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,206.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.82
|
| Rate for Payer: Quartz Commercial |
$1,323.72
|
| Rate for Payer: The Alliance Commercial |
$1,161.16
|
| Rate for Payer: United Healthcare Medicaid |
$267.20
|
| Rate for Payer: WEA Trust Commercial |
$1,277.28
|
| Rate for Payer: WPS Commercial |
$1,720.08
|
|
|
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 |
$46.99 |
| Max. Negotiated Rate |
$1,053.21 |
| Rate for Payer: Aetna Commercial |
$1,053.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.43
|
| Rate for Payer: Aetna Managed Medicare |
$89.08
|
| Rate for Payer: Anthem Medicare Advantage |
$89.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.08
|
| 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 |
$1,053.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.08
|
| Rate for Payer: Health EOS Commercial |
$1,008.86
|
| Rate for Payer: HFN Commercial |
$1,053.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.08
|
| Rate for Payer: Multiplan Commercial |
$886.91
|
| Rate for Payer: NAPHCARE Commercial |
$133.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.21
|
| Rate for Payer: Quartz Beloit One Network |
$487.80
|
| Rate for Payer: Quartz Commercial |
$631.92
|
| Rate for Payer: Quartz Medicare Advantage |
$89.08
|
| Rate for Payer: The Alliance Commercial |
$378.57
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.08
|
| Rate for Payer: WEA Trust Commercial |
$609.75
|
| Rate for Payer: WPS Commercial |
$400.84
|
|
|
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 |
$46.97 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$46.97
|
| Rate for Payer: Anthem Medicare Advantage |
$46.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.97
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.97
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.97
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.45
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$46.97
|
| Rate for Payer: The Alliance Commercial |
$117.42
|
| Rate for Payer: United Healthcare Medicaid |
$128.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.97
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$187.87
|
|
|
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 |
$75.38 |
| Max. Negotiated Rate |
$438.67 |
| Rate for Payer: Aetna Commercial |
$438.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.11
|
| Rate for Payer: Aetna Managed Medicare |
$75.38
|
| Rate for Payer: Anthem Medicare Advantage |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.38
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$438.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.38
|
| Rate for Payer: Health EOS Commercial |
$420.20
|
| Rate for Payer: HFN Commercial |
$438.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.38
|
| Rate for Payer: Multiplan Commercial |
$369.41
|
| Rate for Payer: NAPHCARE Commercial |
$113.07
|
| Rate for Payer: Preferred Network Access Commercial |
$438.67
|
| Rate for Payer: Quartz Beloit One Network |
$203.17
|
| Rate for Payer: Quartz Commercial |
$263.20
|
| Rate for Payer: Quartz Medicare Advantage |
$75.38
|
| Rate for Payer: The Alliance Commercial |
$188.45
|
| Rate for Payer: United Healthcare Medicaid |
$191.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.38
|
| Rate for Payer: WEA Trust Commercial |
$253.97
|
| Rate for Payer: WPS Commercial |
$301.52
|
|
|
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 |
$41.22 |
| Max. Negotiated Rate |
$278.62 |
| Rate for Payer: Aetna Commercial |
$278.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$41.22
|
| Rate for Payer: Anthem Medicare Advantage |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.22
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$278.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.22
|
| Rate for Payer: Health EOS Commercial |
$266.88
|
| Rate for Payer: HFN Commercial |
$278.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.22
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$61.82
|
| Rate for Payer: Preferred Network Access Commercial |
$278.62
|
| Rate for Payer: Quartz Beloit One Network |
$129.04
|
| Rate for Payer: Quartz Commercial |
$167.17
|
| Rate for Payer: Quartz Medicare Advantage |
$41.22
|
| Rate for Payer: The Alliance Commercial |
$103.04
|
| Rate for Payer: United Healthcare Medicaid |
$125.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.22
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$164.86
|
|
|
LASER, ZENKERS DIVERTICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960198
|
|
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, ZENKERS DIVERTICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960198
|
|
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
|
|
|
Lasix 20 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
2958933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Lasix 20 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
2958933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.84
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$1.58
|
|
|
Lasix 20 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
2958933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.63
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$1.58
|
|
|
LASSO 25DEG TIGHT LT QUICKPASS AR-6068-25TL
|
Facility
|
IP
|
$2,902.00
|
|
| Hospital Charge Code |
2964689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
LASSO 25DEG TIGHT LT QUICKPASS AR-6068-25TL
|
Facility
|
OP
|
$2,902.00
|
|
| Hospital Charge Code |
2964689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
LASSO 25DEG TIGHT RT QUICKPASS AR-6068-25TR
|
Facility
|
IP
|
$2,902.00
|
|
| Hospital Charge Code |
2964690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.86 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,810.85
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
LASSO 25DEG TIGHT RT QUICKPASS AR-6068-25TR
|
Facility
|
OP
|
$2,902.00
|
|
| Hospital Charge Code |
2964690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.06 |
| Max. Negotiated Rate |
$2,776.63 |
| Rate for Payer: Aetna Commercial |
$2,716.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.55
|
| Rate for Payer: Aetna Managed Medicare |
$845.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.58
|
| Rate for Payer: Cash Price |
$870.60
|
| Rate for Payer: Cigna Commercial |
$2,776.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.96
|
| Rate for Payer: Health EOS Commercial |
$2,686.09
|
| Rate for Payer: HFN Commercial |
$2,776.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.86
|
| Rate for Payer: Quartz Commercial |
$1,961.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.85
|
| Rate for Payer: The Alliance Commercial |
$1,509.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.94
|
| Rate for Payer: WPS Commercial |
$2,235.41
|
|
|
LASSO CRESCENT QUICKPASS AR-6068C
|
Facility
|
OP
|
$2,347.00
|
|
| Hospital Charge Code |
5385160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.45 |
| Max. Negotiated Rate |
$2,245.61 |
| Rate for Payer: Aetna Commercial |
$2,196.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,099.16
|
| Rate for Payer: Aetna Managed Medicare |
$683.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.67
|
| Rate for Payer: Cash Price |
$704.10
|
| Rate for Payer: Cigna Commercial |
$2,245.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.95
|
| Rate for Payer: Health EOS Commercial |
$2,172.38
|
| Rate for Payer: HFN Commercial |
$2,245.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.66
|
| Rate for Payer: Multiplan Commercial |
$1,952.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,245.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.03
|
| Rate for Payer: Quartz Commercial |
$1,586.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.53
|
| Rate for Payer: The Alliance Commercial |
$1,220.44
|
| Rate for Payer: WEA Trust Commercial |
$1,342.48
|
| Rate for Payer: WPS Commercial |
$1,807.89
|
|
