|
pro BNP
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.59 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.64
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$402.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.40
|
| Rate for Payer: Health EOS Commercial |
$385.84
|
| Rate for Payer: HFN Commercial |
$402.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.59
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.80
|
| Rate for Payer: Quartz Beloit One Network |
$186.56
|
| Rate for Payer: Quartz Commercial |
$241.68
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$233.20
|
| Rate for Payer: WPS Commercial |
$314.06
|
|
|
pro BNP
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$390.08 |
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.17
|
| Rate for Payer: Anthem Medicaid |
$40.57
|
| Rate for Payer: Anthem Medicare Advantage |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.26
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$390.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.27
|
| Rate for Payer: Dean Health Medicaid |
$40.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.26
|
| Rate for Payer: Health EOS Commercial |
$377.36
|
| Rate for Payer: HFN Commercial |
$390.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$40.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.26
|
| Rate for Payer: Managed Health Services Medicaid |
$42.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.26
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: NAPHCARE Commercial |
$58.89
|
| Rate for Payer: Preferred Network Access Commercial |
$390.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40.57
|
| Rate for Payer: Quartz Beloit One Network |
$207.76
|
| Rate for Payer: Quartz Commercial |
$275.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.26
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: United Healthcare Medicaid |
$40.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.26
|
| Rate for Payer: United Healthcare PPO |
$318.00
|
| Rate for Payer: WEA Trust Commercial |
$233.20
|
| Rate for Payer: Wellcare Medicare |
$39.26
|
| Rate for Payer: WMAP Medicaid |
$40.57
|
| Rate for Payer: WPS Commercial |
$314.06
|
|
|
pro BNP
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.76 |
| Max. Negotiated Rate |
$390.08 |
| Rate for Payer: Aetna Commercial |
$381.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.72
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$390.08
|
| Rate for Payer: Health EOS Commercial |
$377.36
|
| Rate for Payer: HFN Commercial |
$390.08
|
| Rate for Payer: Multiplan Commercial |
$339.20
|
| Rate for Payer: NAPHCARE Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$390.08
|
| Rate for Payer: Quartz Beloit One Network |
$207.76
|
| Rate for Payer: Quartz Commercial |
$254.40
|
| Rate for Payer: WEA Trust Commercial |
$233.20
|
| Rate for Payer: WPS Commercial |
$314.06
|
|
|
Procainamide Level
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.80
|
| Rate for Payer: Anthem Medicaid |
$17.31
|
| Rate for Payer: Anthem Medicare Advantage |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.75
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.99
|
| Rate for Payer: Dean Health Medicaid |
$17.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.75
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.75
|
| Rate for Payer: Managed Health Services Medicaid |
$18.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.75
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.31
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$212.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.75
|
| Rate for Payer: The Alliance Commercial |
$67.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.75
|
| Rate for Payer: United Healthcare PPO |
$245.25
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: Wellcare Medicare |
$16.75
|
| Rate for Payer: WMAP Medicaid |
$17.31
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Procainamide Level
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Aetna Commercial |
$310.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$310.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.20
|
| Rate for Payer: Health EOS Commercial |
$297.57
|
| Rate for Payer: HFN Commercial |
$310.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.13
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Preferred Network Access Commercial |
$310.65
|
| Rate for Payer: Quartz Beloit One Network |
$143.88
|
| Rate for Payer: Quartz Commercial |
$186.39
|
| Rate for Payer: The Alliance Commercial |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Procainamide Level
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$196.20
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$196.20
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Procalcitonin
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$285.20 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Aetna Managed Medicare |
$27.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.19
|
| Rate for Payer: Anthem Medicaid |
$28.13
|
| Rate for Payer: Anthem Medicare Advantage |
$27.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.22
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.48
|
| Rate for Payer: Dean Health Medicaid |
$28.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.22
|
| Rate for Payer: Health EOS Commercial |
$275.90
|
| Rate for Payer: HFN Commercial |
$285.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.22
|
| Rate for Payer: Managed Health Services Medicaid |
$29.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.22
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: NAPHCARE Commercial |
$40.83
|
| Rate for Payer: Preferred Network Access Commercial |
$285.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.90
|
| Rate for Payer: Quartz Commercial |
$201.50
|
| Rate for Payer: Quartz Medicare Advantage |
$27.22
|
| Rate for Payer: The Alliance Commercial |
$108.88
|
| Rate for Payer: United Healthcare Medicaid |
$28.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.22
|
| Rate for Payer: United Healthcare PPO |
$232.50
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: Wellcare Medicare |
$27.22
|
| Rate for Payer: WMAP Medicaid |
$28.13
|
| Rate for Payer: WPS Commercial |
$229.62
|
|
|
Procalcitonin
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.09 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$294.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$294.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$155.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.00
|
| Rate for Payer: Health EOS Commercial |
$282.10
|
| Rate for Payer: HFN Commercial |
$294.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.09
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.50
|
| Rate for Payer: Quartz Beloit One Network |
$136.40
|
| Rate for Payer: Quartz Commercial |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$155.00
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: WPS Commercial |
$229.62
|
|
|
Procalcitonin
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$285.20 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.30
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$285.20
|
| Rate for Payer: Health EOS Commercial |
$275.90
|
| Rate for Payer: HFN Commercial |
$285.20
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: NAPHCARE Commercial |
$186.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.20
|
| Rate for Payer: Quartz Beloit One Network |
$151.90
|
| Rate for Payer: Quartz Commercial |
$186.00
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: WPS Commercial |
$229.62
|
|
|
PROCEDURE KIT 36.5MM MSP LEFT MS-SSL
|
Facility
|
IP
|
$7,089.00
|
|
| Hospital Charge Code |
5520866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,473.61 |
| Max. Negotiated Rate |
$6,521.88 |
| Rate for Payer: Aetna Commercial |
$6,380.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,757.17
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,521.88
|
| Rate for Payer: Health EOS Commercial |
$6,309.21
|
| Rate for Payer: HFN Commercial |
$6,521.88
|
| Rate for Payer: Multiplan Commercial |
$5,671.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,253.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.61
|
| Rate for Payer: Quartz Commercial |
$4,253.40
|
| Rate for Payer: WEA Trust Commercial |
$3,898.95
|
| Rate for Payer: WPS Commercial |
$5,250.82
|
|
|
PROCEDURE KIT 36.5MM MSP LEFT MS-SSL
|
Facility
|
OP
|
$7,089.00
|
|
| Hospital Charge Code |
5520866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,984.92 |
| Max. Negotiated Rate |
$28,356.00 |
| Rate for Payer: Aetna Commercial |
$6,380.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,984.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,607.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,544.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,757.17
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,521.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,967.00
|
| Rate for Payer: Health EOS Commercial |
$6,309.21
|
| Rate for Payer: HFN Commercial |
$6,521.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,316.75
|
| Rate for Payer: Multiplan Commercial |
$5,671.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,253.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.61
|
| Rate for Payer: Quartz Commercial |
$4,607.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,253.40
|
| Rate for Payer: The Alliance Commercial |
$28,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,898.95
|
| Rate for Payer: WPS Commercial |
$5,250.82
|
|
|
PROCEDURE KIT 36.5MM MSP RIGHT MS-SSR
|
Facility
|
OP
|
$7,089.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.92 |
| Max. Negotiated Rate |
$28,356.00 |
| Rate for Payer: Aetna Commercial |
$6,380.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,984.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,607.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,544.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,757.17
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,521.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,967.00
|
| Rate for Payer: Health EOS Commercial |
$6,309.21
|
| Rate for Payer: HFN Commercial |
$6,521.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,316.75
|
| Rate for Payer: Multiplan Commercial |
$5,671.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,253.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.61
|
| Rate for Payer: Quartz Commercial |
$4,607.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,253.40
|
| Rate for Payer: The Alliance Commercial |
$28,356.00
|
| Rate for Payer: WEA Trust Commercial |
$3,898.95
|
| Rate for Payer: WPS Commercial |
$5,250.82
|
|
|
PROCEDURE KIT 36.5MM MSP RIGHT MS-SSR
|
Facility
|
IP
|
$7,089.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,473.61 |
| Max. Negotiated Rate |
$6,521.88 |
| Rate for Payer: Aetna Commercial |
$6,380.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,757.17
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,521.88
|
| Rate for Payer: Health EOS Commercial |
$6,309.21
|
| Rate for Payer: HFN Commercial |
$6,521.88
|
| Rate for Payer: Multiplan Commercial |
$5,671.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,253.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.61
|
| Rate for Payer: Quartz Commercial |
$4,253.40
|
| Rate for Payer: WEA Trust Commercial |
$3,898.95
|
| Rate for Payer: WPS Commercial |
$5,250.82
|
|
|
PROCEDURE KIT IOBP FOOT & ANKLE ABS-2020-OT
|
Facility
|
IP
|
$4,608.00
|
|
| Hospital Charge Code |
5885649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,257.92 |
| Max. Negotiated Rate |
$4,239.36 |
| Rate for Payer: Aetna Commercial |
$4,147.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,962.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,442.24
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna Commercial |
$4,239.36
|
| Rate for Payer: Health EOS Commercial |
$4,101.12
|
| Rate for Payer: HFN Commercial |
$4,239.36
|
| Rate for Payer: Multiplan Commercial |
$3,686.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,764.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,239.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.92
|
| Rate for Payer: Quartz Commercial |
$2,764.80
|
| Rate for Payer: WEA Trust Commercial |
$2,534.40
|
| Rate for Payer: WPS Commercial |
$3,413.15
|
|
|
PROCEDURE KIT IOBP FOOT & ANKLE ABS-2020-OT
|
Facility
|
OP
|
$4,608.00
|
|
| Hospital Charge Code |
5885649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,290.24 |
| Max. Negotiated Rate |
$18,432.00 |
| Rate for Payer: Aetna Commercial |
$4,147.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,962.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,290.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,995.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,211.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,442.24
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna Commercial |
$4,239.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,578.64
|
| Rate for Payer: Health EOS Commercial |
$4,101.12
|
| Rate for Payer: HFN Commercial |
$4,239.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,456.00
|
| Rate for Payer: Multiplan Commercial |
$3,686.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,764.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,239.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,257.92
|
| Rate for Payer: Quartz Commercial |
$2,995.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,764.80
|
| Rate for Payer: The Alliance Commercial |
$18,432.00
|
| Rate for Payer: WEA Trust Commercial |
$2,534.40
|
| Rate for Payer: WPS Commercial |
$3,413.15
|
|
|
PROCEDURE KIT TRUCLEAR HYSTEROLUX HUSTEROSCOPIC 72205015
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
6131649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$602.70 |
| Max. Negotiated Rate |
$1,131.60 |
| Rate for Payer: Aetna Commercial |
$1,107.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,057.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$651.90
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,131.60
|
| Rate for Payer: Health EOS Commercial |
$1,094.70
|
| Rate for Payer: HFN Commercial |
$1,131.60
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
| Rate for Payer: NAPHCARE Commercial |
$738.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.60
|
| Rate for Payer: Quartz Beloit One Network |
$602.70
|
| Rate for Payer: Quartz Commercial |
$738.00
|
| Rate for Payer: WEA Trust Commercial |
$676.50
|
| Rate for Payer: WPS Commercial |
$911.06
|
|
|
PROCEDURE KIT TRUCLEAR HYSTEROLUX HUSTEROSCOPIC 72205015
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
6131649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$4,920.00 |
| Rate for Payer: Aetna Commercial |
$1,107.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,057.80
|
| Rate for Payer: Aetna Managed Medicare |
$344.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$799.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$615.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$590.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$651.90
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,131.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.31
|
| Rate for Payer: Health EOS Commercial |
$1,094.70
|
| Rate for Payer: HFN Commercial |
$1,131.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$922.50
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
| Rate for Payer: NAPHCARE Commercial |
$738.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.60
|
| Rate for Payer: Quartz Beloit One Network |
$602.70
|
| Rate for Payer: Quartz Commercial |
$799.50
|
| Rate for Payer: Quartz Medicare Advantage |
$738.00
|
| Rate for Payer: The Alliance Commercial |
$4,920.00
|
| Rate for Payer: WEA Trust Commercial |
$676.50
|
| Rate for Payer: WPS Commercial |
$911.06
|
|
|
PROCEDURE KIT UNILATERAL 2MM
|
Facility
|
OP
|
$3,735.00
|
|
| Hospital Charge Code |
2974022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,045.80 |
| Max. Negotiated Rate |
$14,940.00 |
| Rate for Payer: Aetna Commercial |
$3,361.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,045.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,427.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,867.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,792.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,979.55
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,436.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,090.11
|
| Rate for Payer: Health EOS Commercial |
$3,324.15
|
| Rate for Payer: HFN Commercial |
$3,436.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,801.25
|
| Rate for Payer: Multiplan Commercial |
$2,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,436.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.15
|
| Rate for Payer: Quartz Commercial |
$2,427.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,241.00
|
| Rate for Payer: The Alliance Commercial |
$14,940.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.25
|
| Rate for Payer: WPS Commercial |
$2,766.51
|
|
|
PROCEDURE KIT UNILATERAL 2MM
|
Facility
|
IP
|
$3,735.00
|
|
| Hospital Charge Code |
2974022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,830.15 |
| Max. Negotiated Rate |
$3,436.20 |
| Rate for Payer: Aetna Commercial |
$3,361.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,212.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,979.55
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,436.20
|
| Rate for Payer: Health EOS Commercial |
$3,324.15
|
| Rate for Payer: HFN Commercial |
$3,436.20
|
| Rate for Payer: Multiplan Commercial |
$2,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,241.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,436.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,830.15
|
| Rate for Payer: Quartz Commercial |
$2,241.00
|
| Rate for Payer: WEA Trust Commercial |
$2,054.25
|
| Rate for Payer: WPS Commercial |
$2,766.51
|
|
|
PROCEDURE PACK DYNACLIP 3000-01-000
|
Facility
|
IP
|
$4,208.00
|
|
| Hospital Charge Code |
6226160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,061.92 |
| Max. Negotiated Rate |
$3,871.36 |
| Rate for Payer: Aetna Commercial |
$3,787.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,618.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,230.24
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$3,871.36
|
| Rate for Payer: Health EOS Commercial |
$3,745.12
|
| Rate for Payer: HFN Commercial |
$3,871.36
|
| Rate for Payer: Multiplan Commercial |
$3,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,871.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,061.92
|
| Rate for Payer: Quartz Commercial |
$2,524.80
|
| Rate for Payer: WEA Trust Commercial |
$2,314.40
|
| Rate for Payer: WPS Commercial |
$3,116.87
|
|
|
PROCEDURE PACK DYNACLIP 3000-01-000
|
Facility
|
OP
|
$4,208.00
|
|
| Hospital Charge Code |
6226160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,178.24 |
| Max. Negotiated Rate |
$16,832.00 |
| Rate for Payer: Aetna Commercial |
$3,787.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,618.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,178.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,735.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,019.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,230.24
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$3,871.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.80
|
| Rate for Payer: Health EOS Commercial |
$3,745.12
|
| Rate for Payer: HFN Commercial |
$3,871.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,156.00
|
| Rate for Payer: Multiplan Commercial |
$3,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,871.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,061.92
|
| Rate for Payer: Quartz Commercial |
$2,735.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,524.80
|
| Rate for Payer: The Alliance Commercial |
$16,832.00
|
| Rate for Payer: WEA Trust Commercial |
$2,314.40
|
| Rate for Payer: WPS Commercial |
$3,116.87
|
|
|
Procollagen Type 1 Intact Terminal Propeptide
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5613544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$480.70 |
| Rate for Payer: Aetna Commercial |
$480.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$480.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$460.46
|
| Rate for Payer: HFN Commercial |
$480.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$480.70
|
| Rate for Payer: Quartz Beloit One Network |
$222.64
|
| Rate for Payer: Quartz Commercial |
$288.42
|
| Rate for Payer: The Alliance Commercial |
$253.00
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
Procollagen Type 1 Intact Terminal Propeptide
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5613544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$247.94 |
| Max. Negotiated Rate |
$465.52 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$303.60
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$303.60
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
Procollagen Type 1 Intact Terminal Propeptide
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5613544
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$465.52 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.16
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$328.90
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$379.50
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
Procrit, esrd 1000 units Charge
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
2958985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.83
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$2.07
|
|
