|
LIGATION OF HEMORRHOIDS 46946
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
3014851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.30 |
| Max. Negotiated Rate |
$1,681.38 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.97
|
| Rate for Payer: Aetna Managed Medicare |
$373.64
|
| Rate for Payer: Anthem Medicare Advantage |
$373.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$373.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$373.64
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$711.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Health EOS Commercial |
$681.41
|
| Rate for Payer: HFN Commercial |
$711.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,341.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$373.64
|
| Rate for Payer: Multiplan Commercial |
$599.04
|
| Rate for Payer: NAPHCARE Commercial |
$560.46
|
| Rate for Payer: Preferred Network Access Commercial |
$711.36
|
| Rate for Payer: Quartz Beloit One Network |
$329.47
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: Quartz Medicare Advantage |
$373.64
|
| Rate for Payer: The Alliance Commercial |
$1,587.97
|
| Rate for Payer: United Healthcare Medicaid |
$273.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.64
|
| Rate for Payer: WEA Trust Commercial |
$411.84
|
| Rate for Payer: WPS Commercial |
$1,681.38
|
|
|
Ligation or Biopsy; Temporal Artery
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
1190867
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.01 |
| Max. Negotiated Rate |
$1,221.17 |
| Rate for Payer: Aetna Commercial |
$1,221.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.48
|
| Rate for Payer: Aetna Managed Medicare |
$177.01
|
| Rate for Payer: Anthem Medicare Advantage |
$177.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.01
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cash Price |
$370.80
|
| Rate for Payer: Cigna Commercial |
$1,221.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$1,169.75
|
| Rate for Payer: HFN Commercial |
$1,221.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$695.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$1,028.35
|
| Rate for Payer: NAPHCARE Commercial |
$265.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.17
|
| Rate for Payer: Quartz Beloit One Network |
$565.59
|
| Rate for Payer: Quartz Commercial |
$732.70
|
| Rate for Payer: Quartz Medicare Advantage |
$177.01
|
| Rate for Payer: The Alliance Commercial |
$752.28
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.01
|
| Rate for Payer: WEA Trust Commercial |
$706.99
|
| Rate for Payer: WPS Commercial |
$796.54
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Liletta 1 unit Charge
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$865.78 |
| Max. Negotiated Rate |
$1,869.30 |
| Rate for Payer: Aetna Commercial |
$1,869.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Anthem Commercial |
$878.90
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,869.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$969.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,180.61
|
| Rate for Payer: Health EOS Commercial |
$1,790.59
|
| Rate for Payer: HFN Commercial |
$1,869.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,315.29
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,869.30
|
| Rate for Payer: Quartz Beloit One Network |
$865.78
|
| Rate for Payer: Quartz Commercial |
$1,121.58
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: United Healthcare Medicaid |
$969.00
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
Liletta 1 unit Charge
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,180.61
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
Liletta 1 unit Charge
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
HCPCS J7297
|
| Hospital Charge Code |
5571267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Aetna Managed Medicare |
$550.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,278.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$983.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.14
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,475.76
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,278.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.61
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$107,563.04
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$29,324.58 |
| Max. Negotiated Rate |
$107,563.04 |
| Rate for Payer: Aetna Managed Medicare |
$29,324.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82,105.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,933.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,790.76
|
| Rate for Payer: Anthem Medicare Advantage |
$29,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,324.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,324.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66,373.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,324.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,649.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,324.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,324.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,324.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,324.58
|
| Rate for Payer: NAPHCARE Commercial |
$43,986.87
|
| Rate for Payer: Quartz Medicare Advantage |
$29,324.58
|
| Rate for Payer: The Alliance Commercial |
$107,563.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,324.58
|
| Rate for Payer: United Healthcare PPO |
$61,229.95
|
| Rate for Payer: Wellcare Medicare |
$29,324.58
|
|
|
LINEAR IAB KIT - 34CC 7.5FR
|
Facility
|
OP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,562.56 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,562.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,948.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,392.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,121.60
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,948.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,491.20
|
| Rate for Payer: The Alliance Commercial |
$4,576.00
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
LINEAR IAB KIT - 34CC 7.5FR
|
Facility
|
IP
|
$8,800.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
2973759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,484.48 |
| Max. Negotiated Rate |
$8,419.84 |
| Rate for Payer: Aetna Commercial |
$8,236.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,870.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.56
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$8,419.84
|
| Rate for Payer: Health EOS Commercial |
$8,145.28
|
| Rate for Payer: HFN Commercial |
$8,419.84
|
| Rate for Payer: Multiplan Commercial |
$7,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,419.84
|
| Rate for Payer: Quartz Beloit One Network |
$4,484.48
|
| Rate for Payer: Quartz Commercial |
$5,491.20
|
| Rate for Payer: WEA Trust Commercial |
$5,033.60
|
| Rate for Payer: WPS Commercial |
$6,778.64
|
|
|
LINE IV FLUID FAS1272
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2972097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
LINE IV FLUID FAS1272
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2972097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
LINER 1000CC SUCTION CANISTER 71-6510
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
LINER 1000CC SUCTION CANISTER 71-6510
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
LINER 3000CC SUCTION CANISTER QTXHESL3000B
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
2962822
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
LINER 3000CC SUCTION CANISTER QTXHESL3000B
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
2962822
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
LINER 36X50/52/54 LONGEVITY STD 6305-50-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X50/52/54 LONGEVITY STD 6305-50-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X56 LONGEVITY STD 6305-56-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X56 LONGEVITY STD 6305-56-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X58 10DEG LONGEVITY 6305-58-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X58 10DEG LONGEVITY 6305-58-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X60 10DEG LONGEVITY 6310-60-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X60 10DEG LONGEVITY 6310-60-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X62 10DEG LONGEVITY 6305-62-36
|
Facility
|
OP
|
$9,973.00
|
|
| Hospital Charge Code |
2967751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,904.14 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,904.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,741.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,185.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,978.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.29
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,778.94
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,223.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,741.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6,223.15
|
| Rate for Payer: The Alliance Commercial |
$5,185.96
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
|
LINER 36X62 10DEG LONGEVITY 6305-62-36
|
Facility
|
IP
|
$9,973.00
|
|
| Hospital Charge Code |
2967751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,082.24 |
| Max. Negotiated Rate |
$9,542.17 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,919.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,497.12
|
| Rate for Payer: Cash Price |
$2,991.90
|
| Rate for Payer: Cigna Commercial |
$9,542.17
|
| Rate for Payer: Health EOS Commercial |
$9,231.01
|
| Rate for Payer: HFN Commercial |
$9,542.17
|
| Rate for Payer: Multiplan Commercial |
$8,297.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,542.17
|
| Rate for Payer: Quartz Beloit One Network |
$5,082.24
|
| Rate for Payer: Quartz Commercial |
$6,223.15
|
| Rate for Payer: WEA Trust Commercial |
$5,704.56
|
| Rate for Payer: WPS Commercial |
$7,682.20
|
|
