|
PROBE STRAIGHT FIRE APC 2.3mm
|
Facility
|
OP
|
$2,631.00
|
|
| Hospital Charge Code |
2973899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.15 |
| Max. Negotiated Rate |
$2,517.34 |
| Rate for Payer: Aetna Commercial |
$2,462.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,353.17
|
| Rate for Payer: Aetna Managed Medicare |
$766.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,778.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,368.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,450.21
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cigna Commercial |
$2,517.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,531.24
|
| Rate for Payer: Health EOS Commercial |
$2,435.25
|
| Rate for Payer: HFN Commercial |
$2,517.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,052.18
|
| Rate for Payer: Multiplan Commercial |
$2,188.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,641.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,517.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,340.76
|
| Rate for Payer: Quartz Commercial |
$1,778.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,641.74
|
| Rate for Payer: The Alliance Commercial |
$1,368.12
|
| Rate for Payer: WEA Trust Commercial |
$1,504.93
|
| Rate for Payer: WPS Commercial |
$2,026.66
|
|
|
PROBE STRAIGHT FIRE APC 2.3mm
|
Facility
|
IP
|
$2,631.00
|
|
| Hospital Charge Code |
2973899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,340.76 |
| Max. Negotiated Rate |
$2,517.34 |
| Rate for Payer: Aetna Commercial |
$2,462.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,353.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,450.21
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cigna Commercial |
$2,517.34
|
| Rate for Payer: Health EOS Commercial |
$2,435.25
|
| Rate for Payer: HFN Commercial |
$2,517.34
|
| Rate for Payer: Multiplan Commercial |
$2,188.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,517.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,340.76
|
| Rate for Payer: Quartz Commercial |
$1,641.74
|
| Rate for Payer: WEA Trust Commercial |
$1,504.93
|
| Rate for Payer: WPS Commercial |
$2,026.66
|
|
|
PROBE ULTRASOUND 3.8MM X 403MM LITHOCLAST M0068407170
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
5415201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,240.51 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,240.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,879.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,215.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,126.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,479.32
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,322.80
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,658.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,879.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,658.24
|
| Rate for Payer: The Alliance Commercial |
$2,215.20
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
PROBE ULTRASOUND 3.8MM X 403MM LITHOCLAST M0068407170
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
5415201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,170.90 |
| Max. Negotiated Rate |
$4,075.97 |
| Rate for Payer: Aetna Commercial |
$3,987.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,810.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,348.11
|
| Rate for Payer: Cash Price |
$1,278.00
|
| Rate for Payer: Cigna Commercial |
$4,075.97
|
| Rate for Payer: Health EOS Commercial |
$3,943.06
|
| Rate for Payer: HFN Commercial |
$4,075.97
|
| Rate for Payer: Multiplan Commercial |
$3,544.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,075.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,170.90
|
| Rate for Payer: Quartz Commercial |
$2,658.24
|
| Rate for Payer: WEA Trust Commercial |
$2,436.72
|
| Rate for Payer: WPS Commercial |
$3,281.48
|
|
|
Probing Of Nasolacrimal Duct 68810
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
1190821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$500.81 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$111.29
|
| Rate for Payer: Anthem Medicare Advantage |
$111.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.29
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.29
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.29
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$166.94
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: Quartz Medicare Advantage |
$111.29
|
| Rate for Payer: The Alliance Commercial |
$472.98
|
| Rate for Payer: United Healthcare Medicaid |
$85.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.29
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$500.81
|
|
|
pro BNP
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.07 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$264.58
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
pro BNP
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Aetna Managed Medicare |
$40.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$153.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.78
|
| Rate for Payer: Anthem Medicare Advantage |
$40.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.83
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40.83
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40.83
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: NAPHCARE Commercial |
$61.25
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$286.62
|
| Rate for Payer: Quartz Medicare Advantage |
$40.83
|
| Rate for Payer: The Alliance Commercial |
$163.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.83
|
| Rate for Payer: United Healthcare PPO |
$330.72
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: Wellcare Medicare |
$40.83
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
pro BNP
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
977874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$418.91 |
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Aetna Managed Medicare |
$40.83
|
| Rate for Payer: Anthem Medicare Advantage |
$40.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.83
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$418.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.83
|
| Rate for Payer: Health EOS Commercial |
$401.27
|
| Rate for Payer: HFN Commercial |
$418.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.83
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: NAPHCARE Commercial |
$61.25
|
| Rate for Payer: Preferred Network Access Commercial |
$418.91
|
| Rate for Payer: Quartz Beloit One Network |
$194.02
|
| Rate for Payer: Quartz Commercial |
$251.35
|
| Rate for Payer: Quartz Medicare Advantage |
$40.83
|
| Rate for Payer: The Alliance Commercial |
$161.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.83
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: WPS Commercial |
$179.65
|
|
|
Procainamide Level
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$204.05
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
Procainamide Level
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Commercial |
$323.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$17.42
|
| Rate for Payer: Anthem Medicare Advantage |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.42
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$323.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.42
|
| Rate for Payer: Health EOS Commercial |
$309.47
|
| Rate for Payer: HFN Commercial |
$323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.42
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$26.13
|
| Rate for Payer: Preferred Network Access Commercial |
$323.08
|
| Rate for Payer: Quartz Beloit One Network |
$149.64
|
| Rate for Payer: Quartz Commercial |
$193.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.42
|
| Rate for Payer: The Alliance Commercial |
$68.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.42
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$76.65
|
|
|
Procainamide Level
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
1043010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$17.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.92
|
| Rate for Payer: Anthem Medicare Advantage |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.42
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.42
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.42
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$26.13
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$221.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.42
|
| Rate for Payer: The Alliance Commercial |
$69.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.42
|
| Rate for Payer: United Healthcare PPO |
$255.06
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: Wellcare Medicare |
$17.42
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
Procalcitonin
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Quartz Medicare Advantage |
$28.31
|
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.31
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.31
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.31
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: NAPHCARE Commercial |
$42.46
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$209.56
|
| Rate for Payer: The Alliance Commercial |
$113.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.31
|
| Rate for Payer: United Healthcare PPO |
$241.80
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: Wellcare Medicare |
$28.31
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
Procalcitonin
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$193.44
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
Procalcitonin
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
4744607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$306.28 |
| Rate for Payer: Aetna Commercial |
$306.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.31
|
| Rate for Payer: Anthem Medicare Advantage |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.31
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$306.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.31
|
| Rate for Payer: Health EOS Commercial |
$293.38
|
| Rate for Payer: HFN Commercial |
$306.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.31
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: NAPHCARE Commercial |
$42.46
|
| Rate for Payer: Preferred Network Access Commercial |
$306.28
|
| Rate for Payer: Quartz Beloit One Network |
$141.86
|
| Rate for Payer: Quartz Commercial |
$183.77
|
| Rate for Payer: Quartz Medicare Advantage |
$28.31
|
| Rate for Payer: The Alliance Commercial |
$111.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.31
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$124.56
|
|
|
PROCEDURE KIT 36.5MM MSP LEFT MS-SSL
|
Facility
|
IP
|
$7,089.00
|
|
| Hospital Charge Code |
5520866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,612.55 |
| Max. Negotiated Rate |
$6,782.76 |
| Rate for Payer: Aetna Commercial |
$6,635.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,340.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,907.46
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: Health EOS Commercial |
$6,561.58
|
| Rate for Payer: HFN Commercial |
$6,782.76
|
| Rate for Payer: Multiplan Commercial |
$5,898.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,782.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,612.55
|
| Rate for Payer: Quartz Commercial |
$4,423.54
|
| Rate for Payer: WEA Trust Commercial |
$4,054.91
|
| Rate for Payer: WPS Commercial |
$5,460.66
|
|
|
PROCEDURE KIT 36.5MM MSP LEFT MS-SSL
|
Facility
|
OP
|
$7,089.00
|
|
| Hospital Charge Code |
5520866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,064.32 |
| Max. Negotiated Rate |
$6,782.76 |
| Rate for Payer: Aetna Commercial |
$6,635.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,340.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,064.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,792.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,686.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,538.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,907.46
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,125.80
|
| Rate for Payer: Health EOS Commercial |
$6,561.58
|
| Rate for Payer: HFN Commercial |
$6,782.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,529.42
|
| Rate for Payer: Multiplan Commercial |
$5,898.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,423.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,782.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,612.55
|
| Rate for Payer: Quartz Commercial |
$4,792.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,423.54
|
| Rate for Payer: The Alliance Commercial |
$3,686.28
|
| Rate for Payer: WEA Trust Commercial |
$4,054.91
|
| Rate for Payer: WPS Commercial |
$5,460.66
|
|
|
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 |
$2,064.32 |
| Max. Negotiated Rate |
$6,782.76 |
| Rate for Payer: Aetna Commercial |
$6,635.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,340.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,064.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,792.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,686.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,538.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,907.46
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,125.80
|
| Rate for Payer: Health EOS Commercial |
$6,561.58
|
| Rate for Payer: HFN Commercial |
$6,782.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,529.42
|
| Rate for Payer: Multiplan Commercial |
$5,898.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,423.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,782.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,612.55
|
| Rate for Payer: Quartz Commercial |
$4,792.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,423.54
|
| Rate for Payer: The Alliance Commercial |
$3,686.28
|
| Rate for Payer: WEA Trust Commercial |
$4,054.91
|
| Rate for Payer: WPS Commercial |
$5,460.66
|
|
|
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 |
$3,612.55 |
| Max. Negotiated Rate |
$6,782.76 |
| Rate for Payer: Aetna Commercial |
$6,635.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,340.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,907.46
|
| Rate for Payer: Cash Price |
$2,126.70
|
| Rate for Payer: Cigna Commercial |
$6,782.76
|
| Rate for Payer: Health EOS Commercial |
$6,561.58
|
| Rate for Payer: HFN Commercial |
$6,782.76
|
| Rate for Payer: Multiplan Commercial |
$5,898.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,782.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,612.55
|
| Rate for Payer: Quartz Commercial |
$4,423.54
|
| Rate for Payer: WEA Trust Commercial |
$4,054.91
|
| Rate for Payer: WPS Commercial |
$5,460.66
|
|
|
PROCEDURE KIT IOBP FOOT & ANKLE ABS-2020-OT
|
Facility
|
OP
|
$4,608.00
|
|
| Hospital Charge Code |
5885649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,341.85 |
| Max. Negotiated Rate |
$4,408.93 |
| Rate for Payer: Aetna Commercial |
$4,313.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,341.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,115.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,396.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,300.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,539.93
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna Commercial |
$4,408.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,681.86
|
| Rate for Payer: Health EOS Commercial |
$4,265.16
|
| Rate for Payer: HFN Commercial |
$4,408.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,594.24
|
| Rate for Payer: Multiplan Commercial |
$3,833.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,875.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,408.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.24
|
| Rate for Payer: Quartz Commercial |
$3,115.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,875.39
|
| Rate for Payer: The Alliance Commercial |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,635.78
|
| Rate for Payer: WPS Commercial |
$3,549.54
|
|
|
PROCEDURE KIT IOBP FOOT & ANKLE ABS-2020-OT
|
Facility
|
IP
|
$4,608.00
|
|
| Hospital Charge Code |
5885649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,348.24 |
| Max. Negotiated Rate |
$4,408.93 |
| Rate for Payer: Aetna Commercial |
$4,313.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,539.93
|
| Rate for Payer: Cash Price |
$1,382.40
|
| Rate for Payer: Cigna Commercial |
$4,408.93
|
| Rate for Payer: Health EOS Commercial |
$4,265.16
|
| Rate for Payer: HFN Commercial |
$4,408.93
|
| Rate for Payer: Multiplan Commercial |
$3,833.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,408.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,348.24
|
| Rate for Payer: Quartz Commercial |
$2,875.39
|
| Rate for Payer: WEA Trust Commercial |
$2,635.78
|
| Rate for Payer: WPS Commercial |
$3,549.54
|
|
|
PROCEDURE KIT TRUCLEAR HYSTEROLUX HUSTEROSCOPIC 72205015
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
6131649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.18 |
| Max. Negotiated Rate |
$1,176.86 |
| Rate for Payer: Aetna Commercial |
$1,151.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.11
|
| Rate for Payer: Aetna Managed Medicare |
$358.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$831.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$639.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.98
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,176.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.86
|
| Rate for Payer: Health EOS Commercial |
$1,138.49
|
| Rate for Payer: HFN Commercial |
$1,176.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$959.40
|
| Rate for Payer: Multiplan Commercial |
$1,023.36
|
| Rate for Payer: NAPHCARE Commercial |
$767.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.86
|
| Rate for Payer: Quartz Beloit One Network |
$626.81
|
| Rate for Payer: Quartz Commercial |
$831.48
|
| Rate for Payer: Quartz Medicare Advantage |
$767.52
|
| Rate for Payer: The Alliance Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$703.56
|
| Rate for Payer: WPS Commercial |
$947.47
|
|
|
PROCEDURE KIT TRUCLEAR HYSTEROLUX HUSTEROSCOPIC 72205015
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
6131649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.81 |
| Max. Negotiated Rate |
$1,176.86 |
| Rate for Payer: Aetna Commercial |
$1,151.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$677.98
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$1,176.86
|
| Rate for Payer: Health EOS Commercial |
$1,138.49
|
| Rate for Payer: HFN Commercial |
$1,176.86
|
| Rate for Payer: Multiplan Commercial |
$1,023.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.86
|
| Rate for Payer: Quartz Beloit One Network |
$626.81
|
| Rate for Payer: Quartz Commercial |
$767.52
|
| Rate for Payer: WEA Trust Commercial |
$703.56
|
| Rate for Payer: WPS Commercial |
$947.47
|
|
|
PROCEDURE KIT UNILATERAL 2MM
|
Facility
|
IP
|
$3,735.00
|
|
| Hospital Charge Code |
2974022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,903.36 |
| Max. Negotiated Rate |
$3,573.65 |
| Rate for Payer: Aetna Commercial |
$3,495.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,340.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,058.73
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,573.65
|
| Rate for Payer: Health EOS Commercial |
$3,457.12
|
| Rate for Payer: HFN Commercial |
$3,573.65
|
| Rate for Payer: Multiplan Commercial |
$3,107.52
|
| Rate for Payer: Preferred Network Access Commercial |
$3,573.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.36
|
| Rate for Payer: Quartz Commercial |
$2,330.64
|
| Rate for Payer: WEA Trust Commercial |
$2,136.42
|
| Rate for Payer: WPS Commercial |
$2,877.07
|
|
|
PROCEDURE KIT UNILATERAL 2MM
|
Facility
|
OP
|
$3,735.00
|
|
| Hospital Charge Code |
2974022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,087.63 |
| Max. Negotiated Rate |
$3,573.65 |
| Rate for Payer: Aetna Commercial |
$3,495.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,340.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,524.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,864.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,058.73
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna Commercial |
$3,573.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,173.77
|
| Rate for Payer: Health EOS Commercial |
$3,457.12
|
| Rate for Payer: HFN Commercial |
$3,573.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,913.30
|
| Rate for Payer: Multiplan Commercial |
$3,107.52
|
| Rate for Payer: NAPHCARE Commercial |
$2,330.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,573.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.36
|
| Rate for Payer: Quartz Commercial |
$2,524.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,330.64
|
| Rate for Payer: The Alliance Commercial |
$1,942.20
|
| Rate for Payer: WEA Trust Commercial |
$2,136.42
|
| Rate for Payer: WPS Commercial |
$2,877.07
|
|
|
PROCEDURE PACK DYNACLIP 3000-01-000
|
Facility
|
IP
|
$4,208.00
|
|
| Hospital Charge Code |
6226160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$4,026.21 |
| Rate for Payer: Aetna Commercial |
$3,938.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,763.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,319.45
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$4,026.21
|
| Rate for Payer: Health EOS Commercial |
$3,894.92
|
| Rate for Payer: HFN Commercial |
$4,026.21
|
| Rate for Payer: Multiplan Commercial |
$3,501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,026.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,144.40
|
| Rate for Payer: Quartz Commercial |
$2,625.79
|
| Rate for Payer: WEA Trust Commercial |
$2,406.98
|
| Rate for Payer: WPS Commercial |
$3,241.42
|
|
