|
RENAL ENDOSCOPY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
RENAL ENDOSCOPY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$24,269.00
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$8,729.89 |
| Max. Negotiated Rate |
$24,269.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,729.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,882.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,472.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,750.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,729.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,729.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,729.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,729.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,263.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,729.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,565.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,729.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,729.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,729.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,729.89
|
| Rate for Payer: NAPHCARE Commercial |
$13,094.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,729.89
|
| Rate for Payer: The Alliance Commercial |
$24,269.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,729.89
|
| Rate for Payer: United Healthcare PPO |
$13,675.04
|
| Rate for Payer: Wellcare Medicare |
$8,729.89
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$40,221.00
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$14,467.84 |
| Max. Negotiated Rate |
$40,221.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,467.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,470.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,917.00
|
| Rate for Payer: Anthem Medicare Advantage |
$14,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,467.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,467.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,439.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,467.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,265.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,467.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,467.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,467.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,467.84
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.76
|
| Rate for Payer: Quartz Medicare Advantage |
$14,467.84
|
| Rate for Payer: The Alliance Commercial |
$40,221.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,467.84
|
| Rate for Payer: United Healthcare PPO |
$22,783.64
|
| Rate for Payer: Wellcare Medicare |
$14,467.84
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$16,498.00
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$5,934.53 |
| Max. Negotiated Rate |
$16,498.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,934.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,797.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,809.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,319.58
|
| Rate for Payer: Anthem Medicare Advantage |
$5,934.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,934.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,934.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,934.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,345.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,934.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,865.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,934.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,934.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,934.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,934.53
|
| Rate for Payer: NAPHCARE Commercial |
$8,901.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,934.53
|
| Rate for Payer: The Alliance Commercial |
$16,498.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,934.53
|
| Rate for Payer: United Healthcare PPO |
$9,237.64
|
| Rate for Payer: Wellcare Medicare |
$5,934.53
|
|
|
Renal Func Pnl
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.41
|
| Rate for Payer: Anthem Medicaid |
$8.97
|
| Rate for Payer: Anthem Medicare Advantage |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.68
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.68
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.68
|
| Rate for Payer: Managed Health Services Medicaid |
$9.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.02
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.97
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.68
|
| Rate for Payer: The Alliance Commercial |
$34.72
|
| Rate for Payer: United Healthcare Medicaid |
$8.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.68
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.68
|
| Rate for Payer: WMAP Medicaid |
$8.97
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Renal Func Pnl
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.64
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
|
|
Renal Func Pnl
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
RENAL SHEATH BARD CLEAR 30FR (10MM) X 17CM 992101
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5520789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.75 |
| Max. Negotiated Rate |
$713.00 |
| Rate for Payer: Aetna Commercial |
$697.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.75
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$713.00
|
| Rate for Payer: Health EOS Commercial |
$689.75
|
| Rate for Payer: HFN Commercial |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$620.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.00
|
| Rate for Payer: Preferred Network Access Commercial |
$713.00
|
| Rate for Payer: Quartz Beloit One Network |
$379.75
|
| Rate for Payer: Quartz Commercial |
$465.00
|
| Rate for Payer: WEA Trust Commercial |
$426.25
|
| Rate for Payer: WPS Commercial |
$574.04
|
|
|
RENAL SHEATH BARD CLEAR 30FR (10MM) X 17CM 992101
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5520789
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$3,100.00 |
| Rate for Payer: Aetna Commercial |
$697.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.50
|
| Rate for Payer: Aetna Managed Medicare |
$217.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$503.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$387.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.75
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$713.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.69
|
| Rate for Payer: Health EOS Commercial |
$689.75
|
| Rate for Payer: HFN Commercial |
$713.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$581.25
|
| Rate for Payer: Multiplan Commercial |
$620.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.00
|
| Rate for Payer: Preferred Network Access Commercial |
$713.00
|
| Rate for Payer: Quartz Beloit One Network |
$379.75
|
| Rate for Payer: Quartz Commercial |
$503.75
|
| Rate for Payer: Quartz Medicare Advantage |
$465.00
|
| Rate for Payer: The Alliance Commercial |
$3,100.00
|
| Rate for Payer: WEA Trust Commercial |
$426.25
|
| Rate for Payer: WPS Commercial |
$574.04
|
|
|
RENAL SHEATH CLEAR 34FR X 17CM M0062601600
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5459836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
RENAL SHEATH CLEAR 34FR X 17CM M0062601600
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5459836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$269.36 |
| Max. Negotiated Rate |
$3,848.00 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$269.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.34
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$577.20
|
| Rate for Payer: The Alliance Commercial |
$3,848.00
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
RENAL SHEATH DILATION CATHETER 10MM X 22CM CLEAR X-FORCE 991101
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5520787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.09 |
| Max. Negotiated Rate |
$773.72 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$504.60
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
RENAL SHEATH DILATION CATHETER 10MM X 22CM CLEAR X-FORCE 991101
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5520787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Aetna Managed Medicare |
$235.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.62
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.75
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$546.65
|
| Rate for Payer: Quartz Medicare Advantage |
$504.60
|
| Rate for Payer: The Alliance Commercial |
$3,364.00
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
Renin Activity
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Renin Activity
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Aetna Managed Medicare |
$21.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.50
|
| Rate for Payer: Anthem Medicaid |
$22.72
|
| Rate for Payer: Anthem Medicare Advantage |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.99
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.57
|
| Rate for Payer: Dean Health Medicaid |
$22.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.99
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.99
|
| Rate for Payer: Managed Health Services Medicaid |
$23.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.98
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$306.15
|
| Rate for Payer: Quartz Medicare Advantage |
$21.99
|
| Rate for Payer: The Alliance Commercial |
$87.96
|
| Rate for Payer: United Healthcare Medicaid |
$22.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare PPO |
$353.25
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: Wellcare Medicare |
$21.99
|
| Rate for Payer: WMAP Medicaid |
$22.72
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
Renin Activity
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$268.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$268.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.80
|
| Rate for Payer: Health EOS Commercial |
$257.53
|
| Rate for Payer: HFN Commercial |
$268.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.62
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$268.85
|
| Rate for Payer: Quartz Beloit One Network |
$124.52
|
| Rate for Payer: Quartz Commercial |
$161.31
|
| Rate for Payer: The Alliance Commercial |
$141.50
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Renin Activity
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.79 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$282.60
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
Renin Activity
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$21.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.50
|
| Rate for Payer: Anthem Medicaid |
$22.72
|
| Rate for Payer: Anthem Medicare Advantage |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Dean Health Medicaid |
$22.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.99
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.99
|
| Rate for Payer: Managed Health Services Medicaid |
$23.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$32.98
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$21.99
|
| Rate for Payer: The Alliance Commercial |
$87.96
|
| Rate for Payer: United Healthcare Medicaid |
$22.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare PPO |
$212.25
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: Wellcare Medicare |
$21.99
|
| Rate for Payer: WMAP Medicaid |
$22.72
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Renin Activity
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Aetna Commercial |
$447.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$447.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.60
|
| Rate for Payer: Health EOS Commercial |
$428.61
|
| Rate for Payer: HFN Commercial |
$447.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.62
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$447.45
|
| Rate for Payer: Quartz Beloit One Network |
$207.24
|
| Rate for Payer: Quartz Commercial |
$268.47
|
| Rate for Payer: The Alliance Commercial |
$235.50
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
REOPEN FALLOPIAN TUBE 58350
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
3015109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.59 |
| Max. Negotiated Rate |
$717.25 |
| Rate for Payer: Aetna Commercial |
$717.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$717.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$377.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.00
|
| Rate for Payer: Health EOS Commercial |
$687.05
|
| Rate for Payer: HFN Commercial |
$717.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.59
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.25
|
| Rate for Payer: Quartz Beloit One Network |
$332.20
|
| Rate for Payer: Quartz Commercial |
$430.35
|
| Rate for Payer: The Alliance Commercial |
$377.50
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
Repair (Cheiloplasty) over One-Half Vertical Height or Complex
|
Professional
|
Both
|
$2,019.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
1190862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$529.29 |
| Max. Negotiated Rate |
$1,918.05 |
| Rate for Payer: Aetna Commercial |
$1,918.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,736.34
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cigna Commercial |
$1,918.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$529.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,211.40
|
| Rate for Payer: Health EOS Commercial |
$1,837.29
|
| Rate for Payer: HFN Commercial |
$1,918.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.19
|
| Rate for Payer: Multiplan Commercial |
$1,615.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.05
|
| Rate for Payer: Quartz Beloit One Network |
$888.36
|
| Rate for Payer: Quartz Commercial |
$1,150.83
|
| Rate for Payer: The Alliance Commercial |
$1,009.50
|
| Rate for Payer: United Healthcare Medicaid |
$529.29
|
| Rate for Payer: WEA Trust Commercial |
$1,110.45
|
| Rate for Payer: WPS Commercial |
$1,495.47
|
|
|
Repair, complex (eyelids, nose, ears, lips) 1.1-2.5cm 13151
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
3013616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Aetna Commercial |
$1,009.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,009.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.80
|
| Rate for Payer: Health EOS Commercial |
$967.33
|
| Rate for Payer: HFN Commercial |
$1,009.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$931.43
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.85
|
| Rate for Payer: Quartz Beloit One Network |
$467.72
|
| Rate for Payer: Quartz Commercial |
$605.91
|
| Rate for Payer: The Alliance Commercial |
$531.50
|
| Rate for Payer: United Healthcare Medicaid |
$206.86
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm 13152
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
3013617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.06 |
| Max. Negotiated Rate |
$2,120.40 |
| Rate for Payer: Aetna Commercial |
$2,120.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,919.52
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cigna Commercial |
$2,120.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$277.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.20
|
| Rate for Payer: Health EOS Commercial |
$2,031.12
|
| Rate for Payer: HFN Commercial |
$2,120.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,124.38
|
| Rate for Payer: Multiplan Commercial |
$1,785.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.40
|
| Rate for Payer: Quartz Beloit One Network |
$982.08
|
| Rate for Payer: Quartz Commercial |
$1,272.24
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare Medicaid |
$277.06
|
| Rate for Payer: WEA Trust Commercial |
$1,227.60
|
| Rate for Payer: WPS Commercial |
$1,653.24
|
|
|
Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm 13153
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
4017970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.55 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$1,140.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,140.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.00
|
| Rate for Payer: Health EOS Commercial |
$1,092.00
|
| Rate for Payer: HFN Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.06
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.00
|
| Rate for Payer: Quartz Beloit One Network |
$528.00
|
| Rate for Payer: Quartz Commercial |
$684.00
|
| Rate for Payer: The Alliance Commercial |
$600.00
|
| Rate for Payer: United Healthcare Medicaid |
$140.55
|
| Rate for Payer: WEA Trust Commercial |
$660.00
|
| Rate for Payer: WPS Commercial |
$888.84
|
|
