|
LOCKING DEVICE & BIOPSY CAP RX
|
Facility
|
IP
|
$234.00
|
|
| Hospital Charge Code |
2972332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
LOCKING SCREW GLENOSPHERE EQUINOXE REVERSE SHOULDER 320-15-05
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
LOCKING SCREW GLENOSPHERE EQUINOXE REVERSE SHOULDER 320-15-05
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
LOOP ELECTRICAL EXCISION PROCEDURE CERVIX CONIZATION (LEEP)/CERVIX, COLD CONIZATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
LOOP ELECTRICAL EXCISION PROCEDURE CERVIX CONIZATION (LEEP)/CERVIX, COLD CONIZATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Loop Electrode Excision
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
1188889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$221.38 |
| Max. Negotiated Rate |
$1,467.18 |
| Rate for Payer: Aetna Commercial |
$1,467.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Aetna Managed Medicare |
$221.38
|
| Rate for Payer: Anthem Medicare Advantage |
$221.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$221.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$221.38
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,467.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.38
|
| Rate for Payer: Health EOS Commercial |
$1,405.40
|
| Rate for Payer: HFN Commercial |
$1,467.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$881.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$881.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$221.38
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: NAPHCARE Commercial |
$332.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,467.18
|
| Rate for Payer: Quartz Beloit One Network |
$679.54
|
| Rate for Payer: Quartz Commercial |
$880.31
|
| Rate for Payer: Quartz Medicare Advantage |
$221.38
|
| Rate for Payer: The Alliance Commercial |
$940.89
|
| Rate for Payer: United Healthcare Medicaid |
$241.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.38
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$996.23
|
|
|
LOOP LIGATING DEVICE POLY LOOP
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2973620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.04 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Aetna Managed Medicare |
$548.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,272.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$939.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,095.32
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.96
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,174.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,272.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,174.37
|
| Rate for Payer: The Alliance Commercial |
$978.64
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
LOOP LIGATING DEVICE POLY LOOP
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2973620
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$959.07 |
| Max. Negotiated Rate |
$1,800.70 |
| Rate for Payer: Aetna Commercial |
$1,761.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,683.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,037.36
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,800.70
|
| Rate for Payer: Health EOS Commercial |
$1,741.98
|
| Rate for Payer: HFN Commercial |
$1,800.70
|
| Rate for Payer: Multiplan Commercial |
$1,565.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,800.70
|
| Rate for Payer: Quartz Beloit One Network |
$959.07
|
| Rate for Payer: Quartz Commercial |
$1,174.37
|
| Rate for Payer: WEA Trust Commercial |
$1,076.50
|
| Rate for Payer: WPS Commercial |
$1,449.70
|
|
|
LOOPOGRAM
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
LOOPOGRAM
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
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 |
$2,955.17 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,618.58
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
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 |
$1,688.67 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,688.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,920.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,015.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,894.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,375.02
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,523.22
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,618.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,920.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,618.58
|
| Rate for Payer: The Alliance Commercial |
$3,015.48
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
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 |
$2,955.17 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,618.58
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
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 |
$1,688.67 |
| Max. Negotiated Rate |
$5,548.48 |
| Rate for Payer: Aetna Commercial |
$5,427.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,688.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,920.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,015.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,894.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.41
|
| Rate for Payer: Cash Price |
$1,739.70
|
| Rate for Payer: Cigna Commercial |
$5,548.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,375.02
|
| Rate for Payer: Health EOS Commercial |
$5,367.55
|
| Rate for Payer: HFN Commercial |
$5,548.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,523.22
|
| Rate for Payer: Multiplan Commercial |
$4,824.77
|
| Rate for Payer: NAPHCARE Commercial |
$3,618.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.17
|
| Rate for Payer: Quartz Commercial |
$3,920.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,618.58
|
| Rate for Payer: The Alliance Commercial |
$3,015.48
|
| Rate for Payer: WEA Trust Commercial |
$3,317.03
|
| Rate for Payer: WPS Commercial |
$4,466.97
|
|
|
Loop Recorder Check In Person
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
3052485
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Anthem Medicare Advantage |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.44
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.44
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.44
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$45.66
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$30.44
|
| Rate for Payer: The Alliance Commercial |
$121.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.44
|
| Rate for Payer: United Healthcare PPO |
$259.74
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: Wellcare Medicare |
$30.44
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
Loop Recorder Check In Person
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
3052485
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
Loop Recorder Explant
|
Facility
|
IP
|
$3,763.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
3052402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,917.62 |
| Max. Negotiated Rate |
$3,600.44 |
| Rate for Payer: Aetna Commercial |
$3,522.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,365.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,074.17
|
| Rate for Payer: Cash Price |
$1,128.90
|
| Rate for Payer: Cigna Commercial |
$3,600.44
|
| Rate for Payer: Health EOS Commercial |
$3,483.03
|
| Rate for Payer: HFN Commercial |
$3,600.44
|
| Rate for Payer: Multiplan Commercial |
$3,130.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,600.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,917.62
|
| Rate for Payer: Quartz Commercial |
$2,348.11
|
| Rate for Payer: WEA Trust Commercial |
$2,152.44
|
| Rate for Payer: WPS Commercial |
$2,898.64
|
|
|
Loop Recorder Explant
|
Facility
|
OP
|
$3,763.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
3052402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$745.23 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,522.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,365.63
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,074.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| 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 |
$3,600.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$3,483.03
|
| Rate for Payer: HFN Commercial |
$3,600.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$3,130.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,600.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,917.62
|
| Rate for Payer: Quartz Commercial |
$2,543.79
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$2,152.44
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$2,898.64
|
|
|
Loop Recorder Insertion
|
Facility
|
OP
|
$12,176.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
5460719
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,204.89 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$11,396.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,890.21
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,711.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| 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 |
$11,650.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$11,270.11
|
| Rate for Payer: HFN Commercial |
$11,650.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$10,130.43
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$11,650.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,204.89
|
| Rate for Payer: Quartz Commercial |
$8,230.98
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$6,964.67
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$9,379.17
|
|
|
Loop Recorder Insertion
|
Facility
|
IP
|
$12,176.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
5460719
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,204.89 |
| Max. Negotiated Rate |
$11,650.00 |
| Rate for Payer: Aetna Commercial |
$11,396.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,890.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,711.41
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cigna Commercial |
$11,650.00
|
| Rate for Payer: Health EOS Commercial |
$11,270.11
|
| Rate for Payer: HFN Commercial |
$11,650.00
|
| Rate for Payer: Multiplan Commercial |
$10,130.43
|
| Rate for Payer: Preferred Network Access Commercial |
$11,650.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,204.89
|
| Rate for Payer: Quartz Commercial |
$7,597.82
|
| Rate for Payer: WEA Trust Commercial |
$6,964.67
|
| Rate for Payer: WPS Commercial |
$9,379.17
|
|
|
Loop Recorder Programming
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
3052478
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$220.74
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
Loop Recorder Programming
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
3052478
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
Loop Recorder Programming - Remote 0650T
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 0650T
|
| Hospital Charge Code |
5901634
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$220.74
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
Loop Recorder Programming - Remote 0650T
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 0650T
|
| Hospital Charge Code |
5901634
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
LOOP STOMA CLOSURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960208
|
|
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
|
|
