|
Microalbumin, 24hr Urine w/creat
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4619090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Microalbumin, 24hr Urine w/creat
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4619090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$3.79
|
| Rate for Payer: HFN Commercial |
$3.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3.95
|
| Rate for Payer: Quartz Beloit One Network |
$1.83
|
| Rate for Payer: Quartz Commercial |
$2.37
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
Microdrip Tubing - Peripheral IV Equipment:
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
3788280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$56.68
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Microdrip Tubing - Peripheral IV Equipment:
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
3788280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
MICRO-INTRODUCER MICRO ACCESS 5FR X 10CM STANDARD 06597102
|
Facility
|
OP
|
$484.00
|
|
| Hospital Charge Code |
2963004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
MICRO-INTRODUCER MICRO ACCESS 5FR X 10CM STANDARD 06597102
|
Facility
|
IP
|
$484.00
|
|
| Hospital Charge Code |
2963004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 11CM MIS-7F11
|
Facility
|
IP
|
$626.00
|
|
| Hospital Charge Code |
4069311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 11CM MIS-7F11
|
Facility
|
OP
|
$626.00
|
|
| Hospital Charge Code |
4069311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.29 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$325.52
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 7CM MIS-7F07
|
Facility
|
IP
|
$651.00
|
|
| Hospital Charge Code |
5248717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$622.88 |
| Rate for Payer: Aetna Commercial |
$609.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.83
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$622.88
|
| Rate for Payer: Health EOS Commercial |
$602.57
|
| Rate for Payer: HFN Commercial |
$622.88
|
| Rate for Payer: Multiplan Commercial |
$541.63
|
| Rate for Payer: Preferred Network Access Commercial |
$622.88
|
| Rate for Payer: Quartz Beloit One Network |
$331.75
|
| Rate for Payer: Quartz Commercial |
$406.22
|
| Rate for Payer: WEA Trust Commercial |
$372.37
|
| Rate for Payer: WPS Commercial |
$501.47
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 7CM MIS-7F07
|
Facility
|
OP
|
$651.00
|
|
| Hospital Charge Code |
5248717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.57 |
| Max. Negotiated Rate |
$622.88 |
| Rate for Payer: Aetna Commercial |
$609.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.25
|
| Rate for Payer: Aetna Managed Medicare |
$189.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$338.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.83
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$622.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.88
|
| Rate for Payer: Health EOS Commercial |
$602.57
|
| Rate for Payer: HFN Commercial |
$622.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.78
|
| Rate for Payer: Multiplan Commercial |
$541.63
|
| Rate for Payer: NAPHCARE Commercial |
$406.22
|
| Rate for Payer: Preferred Network Access Commercial |
$622.88
|
| Rate for Payer: Quartz Beloit One Network |
$331.75
|
| Rate for Payer: Quartz Commercial |
$440.08
|
| Rate for Payer: Quartz Medicare Advantage |
$406.22
|
| Rate for Payer: The Alliance Commercial |
$338.52
|
| Rate for Payer: WEA Trust Commercial |
$372.37
|
| Rate for Payer: WPS Commercial |
$501.47
|
|
|
Micromewi Infusion 10cm
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micromewi Infusion 10cm
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micromewi Infusion 10cm
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$2,493.71 |
| Rate for Payer: Aetna Commercial |
$2,493.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,312.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.98
|
| Rate for Payer: Health EOS Commercial |
$2,388.71
|
| Rate for Payer: HFN Commercial |
$2,493.71
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.98
|
| Rate for Payer: Quartz Commercial |
$1,496.23
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micromewi Infusion 5cm
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micromewi Infusion 5cm
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$2,493.71 |
| Rate for Payer: Aetna Commercial |
$2,493.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,312.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.98
|
| Rate for Payer: Health EOS Commercial |
$2,388.71
|
| Rate for Payer: HFN Commercial |
$2,493.71
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.98
|
| Rate for Payer: Quartz Commercial |
$1,496.23
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micromewi Infusion 5cm
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Micropolyspora faeni
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Micropolyspora faeni
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Micropolyspora faeni
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
MICROPULSE P3 PROBES 15522
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6175698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.47 |
| Max. Negotiated Rate |
$2,488.64 |
| Rate for Payer: Aetna Commercial |
$2,434.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.67
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,488.64
|
| Rate for Payer: Health EOS Commercial |
$2,407.49
|
| Rate for Payer: HFN Commercial |
$2,488.64
|
| Rate for Payer: Multiplan Commercial |
$2,164.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.47
|
| Rate for Payer: Quartz Commercial |
$1,623.02
|
| Rate for Payer: WEA Trust Commercial |
$1,487.77
|
| Rate for Payer: WPS Commercial |
$2,003.55
|
|
|
MICROPULSE P3 PROBES 15522
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6175698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.41 |
| Max. Negotiated Rate |
$2,488.64 |
| Rate for Payer: Aetna Commercial |
$2,434.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.33
|
| Rate for Payer: Aetna Managed Medicare |
$757.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,352.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.67
|
| Rate for Payer: Cash Price |
$780.30
|
| Rate for Payer: Cigna Commercial |
$2,488.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,513.78
|
| Rate for Payer: Health EOS Commercial |
$2,407.49
|
| Rate for Payer: HFN Commercial |
$2,488.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.78
|
| Rate for Payer: Multiplan Commercial |
$2,164.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.47
|
| Rate for Payer: Quartz Commercial |
$1,758.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.02
|
| Rate for Payer: The Alliance Commercial |
$1,352.52
|
| Rate for Payer: WEA Trust Commercial |
$1,487.77
|
| Rate for Payer: WPS Commercial |
$2,003.55
|
|
|
Micropuncture 4Fr
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Micropuncture 4Fr
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Micropuncture 4Fr
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Micropuncture 4Fr Ped
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
