|
REMOVE/REPLACE URINARY SPHINCTER
|
Facility
|
IP
|
$9,242.00
|
|
| Hospital Charge Code |
5582025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,709.72 |
| Max. Negotiated Rate |
$8,842.75 |
| Rate for Payer: Aetna Commercial |
$8,650.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.19
|
| Rate for Payer: Cash Price |
$2,772.60
|
| Rate for Payer: Cigna Commercial |
$8,842.75
|
| Rate for Payer: Health EOS Commercial |
$8,554.40
|
| Rate for Payer: HFN Commercial |
$8,842.75
|
| Rate for Payer: Multiplan Commercial |
$7,689.34
|
| Rate for Payer: Preferred Network Access Commercial |
$8,842.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,709.72
|
| Rate for Payer: Quartz Commercial |
$5,767.01
|
| Rate for Payer: WEA Trust Commercial |
$5,286.42
|
| Rate for Payer: WPS Commercial |
$7,119.11
|
|
|
REMOVE/REPLACE URINARY SPHINCTER
|
Facility
|
OP
|
$9,242.00
|
|
| Hospital Charge Code |
5582025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,691.27 |
| Max. Negotiated Rate |
$8,842.75 |
| Rate for Payer: Aetna Commercial |
$8,650.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,691.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,247.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,805.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,613.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.19
|
| Rate for Payer: Cash Price |
$2,772.60
|
| Rate for Payer: Cigna Commercial |
$8,842.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,378.84
|
| Rate for Payer: Health EOS Commercial |
$8,554.40
|
| Rate for Payer: HFN Commercial |
$8,842.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,208.76
|
| Rate for Payer: Multiplan Commercial |
$7,689.34
|
| Rate for Payer: NAPHCARE Commercial |
$5,767.01
|
| Rate for Payer: Preferred Network Access Commercial |
$8,842.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,709.72
|
| Rate for Payer: Quartz Commercial |
$6,247.59
|
| Rate for Payer: Quartz Medicare Advantage |
$5,767.01
|
| Rate for Payer: The Alliance Commercial |
$4,805.84
|
| Rate for Payer: WEA Trust Commercial |
$5,286.42
|
| Rate for Payer: WPS Commercial |
$7,119.11
|
|
|
REMOVER/INSERTER SOFT LENS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2970566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.05
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.34
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$95.47
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$95.47
|
| Rate for Payer: The Alliance Commercial |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
REMOVER/INSERTER SOFT LENS
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2970566
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
REMOVER SKIN PREP LOTION 8610
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2965497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
REMOVER SKIN PREP LOTION 8610
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2965497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$19.34
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$19.34
|
| Rate for Payer: The Alliance Commercial |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
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 |
$297.66 |
| Max. Negotiated Rate |
$1,409.88 |
| Rate for Payer: Aetna Commercial |
$1,409.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$297.66
|
| Rate for Payer: Anthem Medicare Advantage |
$297.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$297.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$297.66
|
| 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 |
$1,409.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.66
|
| Rate for Payer: Health EOS Commercial |
$1,350.51
|
| Rate for Payer: HFN Commercial |
$1,409.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,100.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,100.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$297.66
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$446.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.88
|
| Rate for Payer: Quartz Beloit One Network |
$653.00
|
| Rate for Payer: Quartz Commercial |
$845.93
|
| Rate for Payer: Quartz Medicare Advantage |
$297.66
|
| Rate for Payer: The Alliance Commercial |
$1,265.05
|
| Rate for Payer: United Healthcare Medicaid |
$325.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.66
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$1,339.46
|
|
|
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 |
$682.56 |
| Max. Negotiated Rate |
$12,206.74 |
| Rate for Payer: Aetna Commercial |
$12,206.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,050.31
|
| 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 |
$12,206.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$682.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,709.52
|
| Rate for Payer: Health EOS Commercial |
$11,692.77
|
| Rate for Payer: HFN Commercial |
$12,206.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,499.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,499.16
|
| Rate for Payer: Multiplan Commercial |
$10,279.36
|
| Rate for Payer: Preferred Network Access Commercial |
$12,206.74
|
| Rate for Payer: Quartz Beloit One Network |
$5,653.65
|
| Rate for Payer: Quartz Commercial |
$7,324.04
|
| Rate for Payer: The Alliance Commercial |
$6,424.60
|
| Rate for Payer: United Healthcare Medicaid |
$682.56
|
| Rate for Payer: WEA Trust Commercial |
$7,067.06
|
| Rate for Payer: WPS Commercial |
$9,517.06
|
|
|
REMOVE VAGINA LESION 57130
|
Professional
|
Both
|
$2,519.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
3015070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.43 |
| Max. Negotiated Rate |
$2,488.77 |
| Rate for Payer: Aetna Commercial |
$2,488.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,252.99
|
| Rate for Payer: Aetna Managed Medicare |
$147.43
|
| Rate for Payer: Anthem Medicare Advantage |
$147.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.43
|
| 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 |
$2,488.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.43
|
| Rate for Payer: Health EOS Commercial |
$2,383.98
|
| Rate for Payer: HFN Commercial |
$2,488.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$595.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$595.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.43
|
| Rate for Payer: Multiplan Commercial |
$2,095.81
|
| Rate for Payer: NAPHCARE Commercial |
$221.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,152.69
|
| Rate for Payer: Quartz Commercial |
$1,493.26
|
| Rate for Payer: Quartz Medicare Advantage |
$147.43
|
| Rate for Payer: The Alliance Commercial |
$626.58
|
| Rate for Payer: United Healthcare Medicaid |
$201.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.43
|
| Rate for Payer: WEA Trust Commercial |
$1,440.87
|
| Rate for Payer: WPS Commercial |
$663.44
|
|
|
REMOVE VENTILATING TUBE 69424
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
3015268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$880.31 |
| Rate for Payer: Aetna Commercial |
$880.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Aetna Managed Medicare |
$54.42
|
| Rate for Payer: Anthem Medicare Advantage |
$54.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.42
|
| 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 |
$880.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.42
|
| Rate for Payer: Health EOS Commercial |
$843.24
|
| Rate for Payer: HFN Commercial |
$880.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.42
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$81.63
|
| Rate for Payer: Preferred Network Access Commercial |
$880.31
|
| Rate for Payer: Quartz Beloit One Network |
$407.72
|
| Rate for Payer: Quartz Commercial |
$528.18
|
| Rate for Payer: Quartz Medicare Advantage |
$54.42
|
| Rate for Payer: The Alliance Commercial |
$231.30
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.42
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$244.90
|
|
|
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 |
$36.95 |
| Max. Negotiated Rate |
$299.36 |
| Rate for Payer: Aetna Commercial |
$299.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Aetna Managed Medicare |
$36.95
|
| Rate for Payer: Anthem Medicare Advantage |
$36.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.95
|
| 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 |
$299.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.95
|
| Rate for Payer: Health EOS Commercial |
$286.76
|
| Rate for Payer: HFN Commercial |
$299.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: NAPHCARE Commercial |
$55.43
|
| Rate for Payer: Preferred Network Access Commercial |
$299.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.65
|
| Rate for Payer: Quartz Commercial |
$179.62
|
| Rate for Payer: Quartz Medicare Advantage |
$36.95
|
| Rate for Payer: The Alliance Commercial |
$92.38
|
| Rate for Payer: United Healthcare Medicaid |
$61.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.95
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$147.80
|
|
|
Renal Biopsy
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$531.15 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$531.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| 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 |
$1,745.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.72
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,233.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.18
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
Renal Biopsy
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$929.51 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,138.18
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
Renal Biopsy
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
6175616
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$1,802.11 |
| Rate for Payer: Aetna Commercial |
$1,802.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| 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 |
$1,802.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.18
|
| Rate for Payer: Health EOS Commercial |
$1,726.23
|
| Rate for Payer: HFN Commercial |
$1,802.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.58
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,802.11
|
| Rate for Payer: Quartz Beloit One Network |
$834.66
|
| Rate for Payer: Quartz Commercial |
$1,081.27
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: United Healthcare Medicaid |
$144.98
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$15,519.91
|
|
|
Service Code
|
APR-DRG 4442
|
| Min. Negotiated Rate |
$13,785.75 |
| Max. Negotiated Rate |
$15,519.91 |
| Rate for Payer: Anthem Medicaid |
$14,861.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,861.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,861.17
|
| Rate for Payer: Dean Health Medicaid |
$14,861.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,785.75
|
| Rate for Payer: Managed Health Services Medicaid |
$15,519.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,861.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,861.17
|
| Rate for Payer: United Healthcare Medicaid |
$14,861.17
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$11,223.44
|
|
|
Service Code
|
APR-DRG 4441
|
| Min. Negotiated Rate |
$9,969.36 |
| Max. Negotiated Rate |
$11,223.44 |
| Rate for Payer: Anthem Medicaid |
$10,747.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,747.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,747.06
|
| Rate for Payer: Dean Health Medicaid |
$10,747.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,969.36
|
| Rate for Payer: Managed Health Services Medicaid |
$11,223.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,747.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,747.06
|
| Rate for Payer: United Healthcare Medicaid |
$10,747.06
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$22,008.46
|
|
|
Service Code
|
APR-DRG 4443
|
| Min. Negotiated Rate |
$19,549.29 |
| Max. Negotiated Rate |
$22,008.46 |
| Rate for Payer: Anthem Medicaid |
$21,074.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,074.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,074.31
|
| Rate for Payer: Dean Health Medicaid |
$21,074.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,549.29
|
| Rate for Payer: Managed Health Services Medicaid |
$22,008.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,074.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,074.31
|
| Rate for Payer: United Healthcare Medicaid |
$21,074.31
|
|
|
RENAL DIALYSIS ACCESS DEVICE PROCEDURES
|
Facility
|
IP
|
$35,160.92
|
|
|
Service Code
|
APR-DRG 4444
|
| Min. Negotiated Rate |
$31,232.13 |
| Max. Negotiated Rate |
$35,160.92 |
| Rate for Payer: Anthem Medicaid |
$33,668.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,668.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,668.52
|
| Rate for Payer: Dean Health Medicaid |
$33,668.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31,232.13
|
| Rate for Payer: Managed Health Services Medicaid |
$35,160.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,668.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,668.52
|
| Rate for Payer: United Healthcare Medicaid |
$33,668.52
|
|
|
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 |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$209.96 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$209.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.62
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.38
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$449.90
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$449.90
|
| Rate for Payer: The Alliance Commercial |
$374.92
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$209.96 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$209.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.62
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.38
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$449.90
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$449.90
|
| Rate for Payer: The Alliance Commercial |
$374.92
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$209.96 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$209.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.62
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.38
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$449.90
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$449.90
|
| Rate for Payer: The Alliance Commercial |
$374.92
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$236.16 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Aetna Managed Medicare |
$236.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$548.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.02
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$775.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$472.00
|
| Rate for Payer: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.58
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: NAPHCARE Commercial |
$506.06
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$548.24
|
| Rate for Payer: Quartz Medicare Advantage |
$506.06
|
| Rate for Payer: The Alliance Commercial |
$421.72
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
