|
LOOP LIGATING DEVICE POLY LOOP
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2973620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
LOOP LIGATING DEVICE POLY LOOP
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2973620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
LOOPOGRAM
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
LOOPOGRAM
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
LOOP OLYMPUS BIPOLAR HF 24FR MEDIUM 12 DEG WA22702S/WA22302D
|
Facility
|
IP
|
$5,799.00
|
|
| Hospital Charge Code |
4510812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,841.51 |
| Max. Negotiated Rate |
$5,335.08 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,479.40
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
LOOP OLYMPUS BIPOLAR HF 24FR MEDIUM 12 DEG WA22702S/WA22302D
|
Facility
|
OP
|
$5,799.00
|
|
| Hospital Charge Code |
4510812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,623.72 |
| Max. Negotiated Rate |
$23,196.00 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,623.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,769.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,899.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,783.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,245.12
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,349.25
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,769.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,479.40
|
| Rate for Payer: The Alliance Commercial |
$23,196.00
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
LOOP OLYMPUS BIPOLAR HF 24FR MEDIUM 30 DEG WA22706S/WA22306D
|
Facility
|
IP
|
$5,799.00
|
|
| Hospital Charge Code |
4510813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,841.51 |
| Max. Negotiated Rate |
$5,335.08 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,479.40
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
LOOP OLYMPUS BIPOLAR HF 24FR MEDIUM 30 DEG WA22706S/WA22306D
|
Facility
|
OP
|
$5,799.00
|
|
| Hospital Charge Code |
4510813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,623.72 |
| Max. Negotiated Rate |
$23,196.00 |
| Rate for Payer: Aetna Commercial |
$5,219.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,987.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,623.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,769.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,899.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,783.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,073.47
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,335.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,245.12
|
| Rate for Payer: Health EOS Commercial |
$5,161.11
|
| Rate for Payer: HFN Commercial |
$5,335.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,349.25
|
| Rate for Payer: Multiplan Commercial |
$4,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,335.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,841.51
|
| Rate for Payer: Quartz Commercial |
$3,769.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,479.40
|
| Rate for Payer: The Alliance Commercial |
$23,196.00
|
| Rate for Payer: WEA Trust Commercial |
$3,189.45
|
| Rate for Payer: WPS Commercial |
$4,295.32
|
|
|
Loop Recorder Check In Person
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
3052485
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$29.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Anthem Medicare Advantage |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.43
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.43
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$44.14
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.43
|
| Rate for Payer: The Alliance Commercial |
$117.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.43
|
| Rate for Payer: United Healthcare PPO |
$249.75
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$29.43
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Loop Recorder Check In Person
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
3052485
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Loop Recorder Explant
|
Facility
|
IP
|
$3,763.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
3052402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,843.87 |
| Max. Negotiated Rate |
$3,461.96 |
| Rate for Payer: Aetna Commercial |
$3,386.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,236.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,994.39
|
| Rate for Payer: Cash Price |
$1,128.90
|
| Rate for Payer: Cigna Commercial |
$3,461.96
|
| Rate for Payer: Health EOS Commercial |
$3,349.07
|
| Rate for Payer: HFN Commercial |
$3,461.96
|
| Rate for Payer: Multiplan Commercial |
$3,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,257.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,461.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,843.87
|
| Rate for Payer: Quartz Commercial |
$2,257.80
|
| Rate for Payer: WEA Trust Commercial |
$2,069.65
|
| Rate for Payer: WPS Commercial |
$2,787.25
|
|
|
Loop Recorder Explant
|
Facility
|
OP
|
$3,763.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
3052402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$695.42 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$3,386.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,236.18
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,994.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$1,128.90
|
| Rate for Payer: Cash Price |
$1,128.90
|
| Rate for Payer: Cash Price |
$1,128.90
|
| Rate for Payer: Cigna Commercial |
$3,461.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$3,349.07
|
| Rate for Payer: HFN Commercial |
$3,461.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$3,010.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,461.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,843.87
|
| Rate for Payer: Quartz Commercial |
$2,445.95
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$2,069.65
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$2,787.25
|
|
|
Loop Recorder Insertion
|
Facility
|
OP
|
$12,176.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
5460719
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,966.24 |
| Max. Negotiated Rate |
$33,588.76 |
| Rate for Payer: Aetna Commercial |
$10,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,471.36
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,453.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cigna Commercial |
$11,201.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$10,836.64
|
| Rate for Payer: HFN Commercial |
$11,201.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$9,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$11,201.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,966.24
|
| Rate for Payer: Quartz Commercial |
$7,914.40
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$33,588.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$6,696.80
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$9,018.76
|
|
|
Loop Recorder Insertion
|
Facility
|
IP
|
$12,176.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
5460719
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,966.24 |
| Max. Negotiated Rate |
$11,201.92 |
| Rate for Payer: Aetna Commercial |
$10,958.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,471.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,453.28
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cigna Commercial |
$11,201.92
|
| Rate for Payer: Health EOS Commercial |
$10,836.64
|
| Rate for Payer: HFN Commercial |
$11,201.92
|
| Rate for Payer: Multiplan Commercial |
$9,740.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,201.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,966.24
|
| Rate for Payer: Quartz Commercial |
$7,305.60
|
| Rate for Payer: WEA Trust Commercial |
$6,696.80
|
| Rate for Payer: WPS Commercial |
$9,018.76
|
|
|
Loop Recorder Programming
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
3052478
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$212.25
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Loop Recorder Programming
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
3052478
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Loop Recorder Programming - Remote 0650T
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 0650T
|
| Hospital Charge Code |
5901634
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$212.25
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Loop Recorder Programming - Remote 0650T
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 0650T
|
| Hospital Charge Code |
5901634
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
LOOP STOMA CLOSURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960208
|
|
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
|
|
|
LOOP STOMA CLOSURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960208
|
|
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
|
|
|
LOOP TOE NARROW #554578
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2969889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
LOOP TOE NARROW #554578
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2969889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
LOTION MINERAL BRONZING
|
Facility
|
IP
|
$390.00
|
|
| Hospital Charge Code |
2971051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
LOTION MINERAL BRONZING
|
Facility
|
OP
|
$390.00
|
|
| Hospital Charge Code |
2971051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$109.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.24
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$1,560.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
Lovenox 10 mg Charge
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2958914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.82
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$1.55
|
|
