|
RENAL DILATOR 8FR X 35CM AMPLATZ TYPE M0062601010
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5459469
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$413.29 |
| Max. Negotiated Rate |
$775.96 |
| Rate for Payer: Aetna Commercial |
$759.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| 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: Health EOS Commercial |
$750.66
|
| Rate for Payer: HFN Commercial |
$775.96
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: Preferred Network Access Commercial |
$775.96
|
| Rate for Payer: Quartz Beloit One Network |
$413.29
|
| Rate for Payer: Quartz Commercial |
$506.06
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$624.71
|
|
|
RENAL ENDOSCOPY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
RENAL ENDOSCOPY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
RENAL FAILURE
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00720
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$25,239.76
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$7,213.84 |
| Max. Negotiated Rate |
$25,239.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,213.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,109.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,647.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,915.69
|
| Rate for Payer: Anthem Medicare Advantage |
$7,213.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,213.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,213.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,213.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,447.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,213.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,268.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,213.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,213.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,213.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,213.84
|
| Rate for Payer: NAPHCARE Commercial |
$10,820.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,213.84
|
| Rate for Payer: The Alliance Commercial |
$25,239.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,213.84
|
| Rate for Payer: United Healthcare PPO |
$14,222.04
|
| Rate for Payer: Wellcare Medicare |
$7,213.84
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$41,829.84
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$11,848.56 |
| Max. Negotiated Rate |
$41,829.84 |
| Rate for Payer: Aetna Managed Medicare |
$11,848.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,314.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,768.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,531.79
|
| Rate for Payer: Anthem Medicare Advantage |
$11,848.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,848.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,848.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,848.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,122.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,848.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,436.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,848.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,848.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,848.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,848.56
|
| Rate for Payer: NAPHCARE Commercial |
$17,772.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11,848.56
|
| Rate for Payer: The Alliance Commercial |
$41,829.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,848.56
|
| Rate for Payer: United Healthcare PPO |
$23,694.99
|
| Rate for Payer: Wellcare Medicare |
$11,848.56
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,157.92
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$5,103.99 |
| Max. Negotiated Rate |
$17,157.92 |
| Rate for Payer: Aetna Managed Medicare |
$5,103.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,098.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,039.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,538.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5,103.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,103.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,103.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,103.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,588.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,103.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,340.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,103.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,103.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,103.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,103.99
|
| Rate for Payer: NAPHCARE Commercial |
$7,655.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,103.99
|
| Rate for Payer: The Alliance Commercial |
$17,157.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,103.99
|
| Rate for Payer: United Healthcare PPO |
$9,607.15
|
| Rate for Payer: Wellcare Medicare |
$5,103.99
|
|
|
Renal Func Pnl
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Renal Func Pnl
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Medicare Advantage |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.03
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.03
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.03
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.54
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$9.03
|
| Rate for Payer: The Alliance Commercial |
$35.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.03
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.72
|
|
|
Renal Func Pnl
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
979886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.03
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.03
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.03
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.54
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$9.03
|
| Rate for Payer: The Alliance Commercial |
$36.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.03
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$9.03
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
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 |
$394.94 |
| Max. Negotiated Rate |
$741.52 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$596.98
|
|
|
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 |
$225.68 |
| Max. Negotiated Rate |
$741.52 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Aetna Managed Medicare |
$225.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.05
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.50
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$483.60
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$523.90
|
| Rate for Payer: Quartz Medicare Advantage |
$483.60
|
| Rate for Payer: The Alliance Commercial |
$403.00
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$596.98
|
|
|
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 |
$490.24 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
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 |
$280.13 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$280.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.88
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.36
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$600.29
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$650.31
|
| Rate for Payer: Quartz Medicare Advantage |
$600.29
|
| Rate for Payer: The Alliance Commercial |
$500.24
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
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 |
$244.90 |
| Max. Negotiated Rate |
$804.67 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Aetna Managed Medicare |
$244.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$419.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$804.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.46
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.98
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: NAPHCARE Commercial |
$524.78
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$568.52
|
| Rate for Payer: Quartz Medicare Advantage |
$524.78
|
| Rate for Payer: The Alliance Commercial |
$437.32
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$647.82
|
|
|
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 |
$428.57 |
| Max. Negotiated Rate |
$804.67 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$804.67
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$524.78
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$647.82
|
|
|
Renin Activity
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
Renin Activity
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$22.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.87
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.87
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.87
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$34.30
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$22.87
|
| Rate for Payer: The Alliance Commercial |
$91.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.87
|
| Rate for Payer: United Healthcare PPO |
$220.74
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: Wellcare Medicare |
$22.87
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
Renin Activity
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
2942860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$279.60 |
| Rate for Payer: Aetna Commercial |
$279.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.87
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$279.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.87
|
| Rate for Payer: Health EOS Commercial |
$267.83
|
| Rate for Payer: HFN Commercial |
$279.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.87
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$34.30
|
| Rate for Payer: Preferred Network Access Commercial |
$279.60
|
| Rate for Payer: Quartz Beloit One Network |
$129.50
|
| Rate for Payer: Quartz Commercial |
$167.76
|
| Rate for Payer: Quartz Medicare Advantage |
$22.87
|
| Rate for Payer: The Alliance Commercial |
$90.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.87
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$100.63
|
|
|
Renin Activity
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$465.35 |
| Rate for Payer: Aetna Commercial |
$465.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.87
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$465.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.87
|
| Rate for Payer: Health EOS Commercial |
$445.75
|
| Rate for Payer: HFN Commercial |
$465.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.87
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$34.30
|
| Rate for Payer: Preferred Network Access Commercial |
$465.35
|
| Rate for Payer: Quartz Beloit One Network |
$215.53
|
| Rate for Payer: Quartz Commercial |
$279.21
|
| Rate for Payer: Quartz Medicare Advantage |
$22.87
|
| Rate for Payer: The Alliance Commercial |
$90.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.87
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$100.63
|
|
|
Renin Activity
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
Renin Activity
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
978054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$22.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.87
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.87
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.87
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$34.30
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$22.87
|
| Rate for Payer: The Alliance Commercial |
$91.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.87
|
| Rate for Payer: United Healthcare PPO |
$367.38
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: Wellcare Medicare |
$22.87
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
REOPEN FALLOPIAN TUBE 58350
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
3015109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$745.94 |
| Rate for Payer: Aetna Commercial |
$745.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Aetna Managed Medicare |
$80.96
|
| Rate for Payer: Anthem Medicare Advantage |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.96
|
| 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 |
$745.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$714.53
|
| Rate for Payer: HFN Commercial |
$745.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: NAPHCARE Commercial |
$121.45
|
| Rate for Payer: Preferred Network Access Commercial |
$745.94
|
| Rate for Payer: Quartz Beloit One Network |
$345.49
|
| Rate for Payer: Quartz Commercial |
$447.56
|
| Rate for Payer: Quartz Medicare Advantage |
$80.96
|
| Rate for Payer: The Alliance Commercial |
$344.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.96
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$364.34
|
|
|
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 |
$382.05 |
| Max. Negotiated Rate |
$1,994.77 |
| Rate for Payer: Aetna Commercial |
$1,994.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,805.79
|
| Rate for Payer: Aetna Managed Medicare |
$382.05
|
| Rate for Payer: Anthem Medicare Advantage |
$382.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$382.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$382.05
|
| 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 |
$1,994.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$550.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.05
|
| Rate for Payer: Health EOS Commercial |
$1,910.78
|
| Rate for Payer: HFN Commercial |
$1,994.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,467.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$382.05
|
| Rate for Payer: Multiplan Commercial |
$1,679.81
|
| Rate for Payer: NAPHCARE Commercial |
$573.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,994.77
|
| Rate for Payer: Quartz Beloit One Network |
$923.89
|
| Rate for Payer: Quartz Commercial |
$1,196.86
|
| Rate for Payer: Quartz Medicare Advantage |
$382.05
|
| Rate for Payer: The Alliance Commercial |
$1,623.73
|
| Rate for Payer: United Healthcare Medicaid |
$550.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.05
|
| Rate for Payer: WEA Trust Commercial |
$1,154.87
|
| Rate for Payer: WPS Commercial |
$1,719.24
|
|
|
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 |
$215.13 |
| Max. Negotiated Rate |
$1,050.24 |
| Rate for Payer: Aetna Commercial |
$1,050.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$950.75
|
| Rate for Payer: Aetna Managed Medicare |
$227.17
|
| Rate for Payer: Anthem Medicare Advantage |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.17
|
| 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 |
$1,050.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.17
|
| Rate for Payer: Health EOS Commercial |
$1,006.02
|
| Rate for Payer: HFN Commercial |
$1,050.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$968.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$884.42
|
| Rate for Payer: NAPHCARE Commercial |
$340.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,050.24
|
| Rate for Payer: Quartz Beloit One Network |
$486.43
|
| Rate for Payer: Quartz Commercial |
$630.15
|
| Rate for Payer: Quartz Medicare Advantage |
$227.17
|
| Rate for Payer: The Alliance Commercial |
$965.46
|
| Rate for Payer: United Healthcare Medicaid |
$215.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.17
|
| Rate for Payer: WEA Trust Commercial |
$608.04
|
| Rate for Payer: WPS Commercial |
$1,022.25
|
|
