|
REMOVER CONTACT LENS DMU ULTRA
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2969598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
REMOVER CONTACT LENS DMU ULTRA
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2969598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.97
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$45.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
REMOVE RENAL TUBE W/FLUORO 50389
|
Professional
|
Both
|
$4,294.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
3014928
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.75 |
| Max. Negotiated Rate |
$4,079.30 |
| Rate for Payer: Aetna Commercial |
$4,079.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,692.84
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,079.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,576.40
|
| Rate for Payer: Health EOS Commercial |
$3,907.54
|
| Rate for Payer: HFN Commercial |
$4,079.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.75
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.36
|
| Rate for Payer: Quartz Commercial |
$2,447.58
|
| Rate for Payer: The Alliance Commercial |
$2,147.00
|
| Rate for Payer: United Healthcare Medicaid |
$423.81
|
| Rate for Payer: WEA Trust Commercial |
$2,361.70
|
| Rate for Payer: WPS Commercial |
$3,180.57
|
|
|
REMOVE/REPLACE URINARY SPHINCTER
|
Facility
|
OP
|
$9,242.00
|
|
| Hospital Charge Code |
5582025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,587.76 |
| Max. Negotiated Rate |
$36,968.00 |
| Rate for Payer: Aetna Commercial |
$8,317.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,948.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,587.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,007.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,436.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,898.26
|
| Rate for Payer: Cash Price |
$2,772.60
|
| Rate for Payer: Cigna Commercial |
$8,502.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,171.82
|
| Rate for Payer: Health EOS Commercial |
$8,225.38
|
| Rate for Payer: HFN Commercial |
$8,502.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,931.50
|
| Rate for Payer: Multiplan Commercial |
$7,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,545.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,502.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,528.58
|
| Rate for Payer: Quartz Commercial |
$6,007.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,545.20
|
| Rate for Payer: The Alliance Commercial |
$36,968.00
|
| Rate for Payer: WEA Trust Commercial |
$5,083.10
|
| Rate for Payer: WPS Commercial |
$6,845.55
|
|
|
REMOVE/REPLACE URINARY SPHINCTER
|
Facility
|
IP
|
$9,242.00
|
|
| Hospital Charge Code |
5582025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,528.58 |
| Max. Negotiated Rate |
$8,502.64 |
| Rate for Payer: Aetna Commercial |
$8,317.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,948.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,898.26
|
| Rate for Payer: Cash Price |
$2,772.60
|
| Rate for Payer: Cigna Commercial |
$8,502.64
|
| Rate for Payer: Health EOS Commercial |
$8,225.38
|
| Rate for Payer: HFN Commercial |
$8,502.64
|
| Rate for Payer: Multiplan Commercial |
$7,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,545.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,502.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,528.58
|
| Rate for Payer: Quartz Commercial |
$5,545.20
|
| Rate for Payer: WEA Trust Commercial |
$5,083.10
|
| Rate for Payer: WPS Commercial |
$6,845.55
|
|
|
REMOVER/INSERTER SOFT LENS
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2970566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
REMOVER/INSERTER SOFT LENS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2970566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
REMOVER SKIN PREP LOTION 8610
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2965497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.60
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
REMOVER SKIN PREP LOTION 8610
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2965497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
REMOVE TENDON SHEATH LESION 26160
|
Professional
|
Both
|
$1,427.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
3013947
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$312.96 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Aetna Commercial |
$1,355.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,355.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.20
|
| Rate for Payer: Health EOS Commercial |
$1,298.57
|
| Rate for Payer: HFN Commercial |
$1,355.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,058.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,058.29
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,355.65
|
| Rate for Payer: Quartz Beloit One Network |
$627.88
|
| Rate for Payer: Quartz Commercial |
$813.39
|
| Rate for Payer: The Alliance Commercial |
$713.50
|
| Rate for Payer: United Healthcare Medicaid |
$312.96
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
REMOVE TUMOR OF ARM/ELBOW -BILATERAL 2407750
|
Professional
|
Both
|
$12,355.00
|
|
|
Service Code
|
CPT 24077 50
|
| Hospital Charge Code |
6171945
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$656.31 |
| Max. Negotiated Rate |
$11,737.25 |
| Rate for Payer: Aetna Commercial |
$11,737.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,625.30
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cash Price |
$3,706.50
|
| Rate for Payer: Cigna Commercial |
$11,737.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,413.00
|
| Rate for Payer: Health EOS Commercial |
$11,243.05
|
| Rate for Payer: HFN Commercial |
$11,737.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,364.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,364.58
|
| Rate for Payer: Multiplan Commercial |
$9,884.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,737.25
|
| Rate for Payer: Quartz Beloit One Network |
$5,436.20
|
| Rate for Payer: Quartz Commercial |
$7,042.35
|
| Rate for Payer: The Alliance Commercial |
$6,177.50
|
| Rate for Payer: United Healthcare Medicaid |
$656.31
|
| Rate for Payer: WEA Trust Commercial |
$6,795.25
|
| Rate for Payer: WPS Commercial |
$9,151.35
|
|
|
REMOVE VAGINA LESION 57130
|
Professional
|
Both
|
$2,519.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
3015070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.65 |
| Max. Negotiated Rate |
$2,393.05 |
| Rate for Payer: Aetna Commercial |
$2,393.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,166.34
|
| Rate for Payer: Cash Price |
$755.70
|
| Rate for Payer: Cash Price |
$755.70
|
| Rate for Payer: Cash Price |
$755.70
|
| Rate for Payer: Cigna Commercial |
$2,393.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,511.40
|
| Rate for Payer: Health EOS Commercial |
$2,292.29
|
| Rate for Payer: HFN Commercial |
$2,393.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$572.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$572.50
|
| Rate for Payer: Multiplan Commercial |
$2,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,393.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.36
|
| Rate for Payer: Quartz Commercial |
$1,435.83
|
| Rate for Payer: The Alliance Commercial |
$1,259.50
|
| Rate for Payer: United Healthcare Medicaid |
$193.65
|
| Rate for Payer: WEA Trust Commercial |
$1,385.45
|
| Rate for Payer: WPS Commercial |
$1,865.82
|
|
|
REMOVE VENTILATING TUBE 69424
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
3015268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Aetna Commercial |
$846.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$846.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.60
|
| Rate for Payer: Health EOS Commercial |
$810.81
|
| Rate for Payer: HFN Commercial |
$846.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$201.53
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$846.45
|
| Rate for Payer: Quartz Beloit One Network |
$392.04
|
| Rate for Payer: Quartz Commercial |
$507.87
|
| Rate for Payer: The Alliance Commercial |
$445.50
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
RENAL ARTERY VASCULAR STUDY 9397626
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
CPT 93976 26
|
| Hospital Charge Code |
3015443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$287.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$287.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.80
|
| Rate for Payer: Health EOS Commercial |
$275.73
|
| Rate for Payer: HFN Commercial |
$287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$287.85
|
| Rate for Payer: Quartz Beloit One Network |
$133.32
|
| Rate for Payer: Quartz Commercial |
$172.71
|
| Rate for Payer: The Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicaid |
$178.91
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
Renal Biopsy
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,732.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,732.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.40
|
| Rate for Payer: Health EOS Commercial |
$1,659.84
|
| Rate for Payer: HFN Commercial |
$1,732.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.44
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.80
|
| Rate for Payer: Quartz Beloit One Network |
$802.56
|
| Rate for Payer: Quartz Commercial |
$1,039.68
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare Medicaid |
$139.40
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
Renal Biopsy
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$893.76 |
| Max. Negotiated Rate |
$1,678.08 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,094.40
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
Renal Biopsy
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$893.76 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
RENAL DILATOR 10FR X 35CM AMPLATZ TYPE M0062601020
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 10FR X 35CM AMPLATZ TYPE M0062601020
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 12FR X 35CM AMPLATZ TYPE M0062601030
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 12FR X 35CM AMPLATZ TYPE M0062601030
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 14FR X 35CM AMPLATZ TYPE M0062601040
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 14FR X 35CM AMPLATZ TYPE M0062601040
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6165638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
RENAL DILATOR 8FR X 35CM AMPLATZ TYPE M0062601010
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5459469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.08 |
| Max. Negotiated Rate |
$3,244.00 |
| Rate for Payer: Aetna Commercial |
$729.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.46
|
| Rate for Payer: Aetna Managed Medicare |
$227.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.83
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$746.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.84
|
| Rate for Payer: Health EOS Commercial |
$721.79
|
| Rate for Payer: HFN Commercial |
$746.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$648.80
|
| Rate for Payer: NAPHCARE Commercial |
$486.60
|
| Rate for Payer: Preferred Network Access Commercial |
$746.12
|
| Rate for Payer: Quartz Beloit One Network |
$397.39
|
| Rate for Payer: Quartz Commercial |
$527.15
|
| Rate for Payer: Quartz Medicare Advantage |
$486.60
|
| Rate for Payer: The Alliance Commercial |
$3,244.00
|
| Rate for Payer: WEA Trust Commercial |
$446.05
|
| Rate for Payer: WPS Commercial |
$600.71
|
|
|
RENAL DILATOR 8FR X 35CM AMPLATZ TYPE M0062601010
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5459469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.39 |
| Max. Negotiated Rate |
$746.12 |
| Rate for Payer: Aetna Commercial |
$729.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.83
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$721.79
|
| Rate for Payer: HFN Commercial |
$746.12
|
| Rate for Payer: Multiplan Commercial |
$648.80
|
| Rate for Payer: NAPHCARE Commercial |
$486.60
|
| Rate for Payer: Preferred Network Access Commercial |
$746.12
|
| Rate for Payer: Quartz Beloit One Network |
$397.39
|
| Rate for Payer: Quartz Commercial |
$486.60
|
| Rate for Payer: WEA Trust Commercial |
$446.05
|
| Rate for Payer: WPS Commercial |
$600.71
|
|
