|
RELOAD RELIATACK 5 DEEP RELTACK5RDPTSW
|
Facility
|
IP
|
$1,756.00
|
|
| Hospital Charge Code |
4640928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
RELOAD RELIATACK 8 DEEP RELTACK8RDPTSW
|
Facility
|
OP
|
$2,392.00
|
|
| Hospital Charge Code |
4640733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.76 |
| Max. Negotiated Rate |
$9,568.00 |
| Rate for Payer: Aetna Commercial |
$2,152.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,057.12
|
| Rate for Payer: Aetna Managed Medicare |
$669.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,554.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,196.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.76
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,200.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,338.56
|
| Rate for Payer: Health EOS Commercial |
$2,128.88
|
| Rate for Payer: HFN Commercial |
$2,200.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.08
|
| Rate for Payer: Quartz Commercial |
$1,554.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,435.20
|
| Rate for Payer: The Alliance Commercial |
$9,568.00
|
| Rate for Payer: WEA Trust Commercial |
$1,315.60
|
| Rate for Payer: WPS Commercial |
$1,771.75
|
|
|
RELOAD RELIATACK 8 DEEP RELTACK8RDPTSW
|
Facility
|
IP
|
$2,392.00
|
|
| Hospital Charge Code |
4640733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.08 |
| Max. Negotiated Rate |
$2,200.64 |
| Rate for Payer: Aetna Commercial |
$2,152.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,057.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,267.76
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,200.64
|
| Rate for Payer: Health EOS Commercial |
$2,128.88
|
| Rate for Payer: HFN Commercial |
$2,200.64
|
| Rate for Payer: Multiplan Commercial |
$1,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,172.08
|
| Rate for Payer: Quartz Commercial |
$1,435.20
|
| Rate for Payer: WEA Trust Commercial |
$1,315.60
|
| Rate for Payer: WPS Commercial |
$1,771.75
|
|
|
Rem endovas vena cava filter 37193
|
Professional
|
Both
|
$7,139.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3014545
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,142.73 |
| Max. Negotiated Rate |
$6,782.05 |
| Rate for Payer: Aetna Commercial |
$6,782.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,139.54
|
| Rate for Payer: Cash Price |
$2,141.70
|
| Rate for Payer: Cash Price |
$2,141.70
|
| Rate for Payer: Cigna Commercial |
$6,782.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,304.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,283.40
|
| Rate for Payer: Health EOS Commercial |
$6,496.49
|
| Rate for Payer: HFN Commercial |
$6,782.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,142.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,142.73
|
| Rate for Payer: Multiplan Commercial |
$5,711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,782.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,141.16
|
| Rate for Payer: Quartz Commercial |
$4,069.23
|
| Rate for Payer: The Alliance Commercial |
$3,569.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,304.75
|
| Rate for Payer: WEA Trust Commercial |
$3,926.45
|
| Rate for Payer: WPS Commercial |
$5,287.86
|
|
|
Remicade 10 mg Charge
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Aetna Managed Medicare |
$32.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.67
|
| Rate for Payer: Anthem Medicare Advantage |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.16
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.16
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$48.24
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$212.55
|
| Rate for Payer: Quartz Medicare Advantage |
$32.16
|
| Rate for Payer: The Alliance Commercial |
$128.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.16
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: Wellcare Medicare |
$32.16
|
| Rate for Payer: WPS Commercial |
$79.18
|
|
|
Remicade 10 mg Charge
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$196.20
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$196.20
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Remicade 10 mg Charge
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Aetna Commercial |
$310.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$310.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.67
|
| Rate for Payer: Health EOS Commercial |
$297.57
|
| Rate for Payer: HFN Commercial |
$310.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Preferred Network Access Commercial |
$310.65
|
| Rate for Payer: Quartz Beloit One Network |
$143.88
|
| Rate for Payer: Quartz Commercial |
$186.39
|
| Rate for Payer: The Alliance Commercial |
$163.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.67
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$79.18
|
|
|
Rem Impacted Cerumen Irrigation/LVG Unilat 69209
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4598872
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$203.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.40
|
| Rate for Payer: Health EOS Commercial |
$194.74
|
| Rate for Payer: HFN Commercial |
$203.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.27
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Preferred Network Access Commercial |
$203.30
|
| Rate for Payer: Quartz Beloit One Network |
$94.16
|
| Rate for Payer: Quartz Commercial |
$121.98
|
| Rate for Payer: The Alliance Commercial |
$107.00
|
| Rate for Payer: United Healthcare Medicaid |
$9.74
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
REM INTERROG DEV EVAL ICPMS <30 D PHYS/QHP
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
6182854
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$237.60
|
| Rate for Payer: The Alliance Commercial |
$1,584.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
REM INTERROG DEV EVAL ICPMS <30 D PHYS/QHP
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
6182854
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
Rem or Insert Suprapubic Cath
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3005559
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$407.25
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
Rem or Insert Suprapubic Cath
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3005559
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
IP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.42 |
| Max. Negotiated Rate |
$1,249.36 |
| Rate for Payer: Aetna Commercial |
$1,222.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.74
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,249.36
|
| Rate for Payer: Health EOS Commercial |
$1,208.62
|
| Rate for Payer: HFN Commercial |
$1,249.36
|
| Rate for Payer: Multiplan Commercial |
$1,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$814.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.36
|
| Rate for Payer: Quartz Beloit One Network |
$665.42
|
| Rate for Payer: Quartz Commercial |
$814.80
|
| Rate for Payer: WEA Trust Commercial |
$746.90
|
| Rate for Payer: WPS Commercial |
$1,005.87
|
|
|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
OP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.24 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: Aetna Commercial |
$1,222.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.88
|
| Rate for Payer: Aetna Managed Medicare |
$380.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.74
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,249.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.94
|
| Rate for Payer: Health EOS Commercial |
$1,208.62
|
| Rate for Payer: HFN Commercial |
$1,249.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$814.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.36
|
| Rate for Payer: Quartz Beloit One Network |
$665.42
|
| Rate for Payer: Quartz Commercial |
$882.70
|
| Rate for Payer: Quartz Medicare Advantage |
$814.80
|
| Rate for Payer: The Alliance Commercial |
$5,432.00
|
| Rate for Payer: WEA Trust Commercial |
$746.90
|
| Rate for Payer: WPS Commercial |
$1,005.87
|
|
|
Remote Pacer Interogation
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$391.92 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.48
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$276.90
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$319.50
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
Remote Pacer Interogation
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$391.92 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$255.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$255.60
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
REMOVAL FOREIGN BODY, GUM 41805
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
3014620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$697.70 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.74
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$293.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.40
|
| Rate for Payer: Health EOS Commercial |
$281.19
|
| Rate for Payer: HFN Commercial |
$293.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$697.70
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$293.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.96
|
| Rate for Payer: Quartz Commercial |
$176.13
|
| Rate for Payer: The Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Medicaid |
$43.75
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
REMOVAL HAND LESION SUBCUT 26115
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
3013940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,331.28
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$1,470.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$928.80
|
| Rate for Payer: Health EOS Commercial |
$1,408.68
|
| Rate for Payer: HFN Commercial |
$1,470.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,106.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,106.55
|
| Rate for Payer: Multiplan Commercial |
$1,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,470.60
|
| Rate for Payer: Quartz Beloit One Network |
$681.12
|
| Rate for Payer: Quartz Commercial |
$882.36
|
| Rate for Payer: The Alliance Commercial |
$774.00
|
| Rate for Payer: United Healthcare Medicaid |
$109.90
|
| Rate for Payer: WEA Trust Commercial |
$851.40
|
| Rate for Payer: WPS Commercial |
$1,146.60
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,543.64 |
| Max. Negotiated Rate |
$16,041.12 |
| Rate for Payer: Aetna Commercial |
$15,692.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,994.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,241.08
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,041.12
|
| Rate for Payer: Health EOS Commercial |
$15,518.04
|
| Rate for Payer: HFN Commercial |
$16,041.12
|
| Rate for Payer: Multiplan Commercial |
$13,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,041.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,543.64
|
| Rate for Payer: Quartz Commercial |
$10,461.60
|
| Rate for Payer: WEA Trust Commercial |
$9,589.80
|
| Rate for Payer: WPS Commercial |
$12,914.85
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,882.08 |
| Max. Negotiated Rate |
$69,744.00 |
| Rate for Payer: Aetna Commercial |
$15,692.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,994.96
|
| Rate for Payer: Aetna Managed Medicare |
$4,882.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,333.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,718.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,369.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,241.08
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,041.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$15,518.04
|
| Rate for Payer: HFN Commercial |
$16,041.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,077.00
|
| Rate for Payer: Multiplan Commercial |
$13,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,041.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,543.64
|
| Rate for Payer: Quartz Commercial |
$11,333.40
|
| Rate for Payer: Quartz Medicare Advantage |
$10,461.60
|
| Rate for Payer: The Alliance Commercial |
$69,744.00
|
| Rate for Payer: WEA Trust Commercial |
$9,589.80
|
| Rate for Payer: WPS Commercial |
$12,914.85
|
|
|
REMOVAL OF ANAL FISSURE 46200
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
3014826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$1,343.30 |
| Rate for Payer: Aetna Commercial |
$1,343.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.04
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$1,343.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.40
|
| Rate for Payer: Health EOS Commercial |
$1,286.74
|
| Rate for Payer: HFN Commercial |
$1,343.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,128.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,128.47
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,343.30
|
| Rate for Payer: Quartz Beloit One Network |
$622.16
|
| Rate for Payer: Quartz Commercial |
$805.98
|
| Rate for Payer: The Alliance Commercial |
$707.00
|
| Rate for Payer: United Healthcare Medicaid |
$209.35
|
| Rate for Payer: WEA Trust Commercial |
$777.70
|
| Rate for Payer: WPS Commercial |
$1,047.35
|
|
|
REMOVAL OF ANAL FISTULA 46270
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
3014836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,330.67 |
| Rate for Payer: Aetna Commercial |
$900.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.28
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$900.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.80
|
| Rate for Payer: Health EOS Commercial |
$862.68
|
| Rate for Payer: HFN Commercial |
$900.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,330.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,330.67
|
| Rate for Payer: Multiplan Commercial |
$758.40
|
| Rate for Payer: Preferred Network Access Commercial |
$900.60
|
| Rate for Payer: Quartz Beloit One Network |
$417.12
|
| Rate for Payer: Quartz Commercial |
$540.36
|
| Rate for Payer: The Alliance Commercial |
$474.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$521.40
|
| Rate for Payer: WPS Commercial |
$702.18
|
|
|
REMOVAL OF ANAL FISTULA 46275
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
3014837
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.65 |
| Max. Negotiated Rate |
$1,901.90 |
| Rate for Payer: Aetna Commercial |
$1,901.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,721.72
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,901.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.20
|
| Rate for Payer: Health EOS Commercial |
$1,821.82
|
| Rate for Payer: HFN Commercial |
$1,901.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,405.79
|
| Rate for Payer: Multiplan Commercial |
$1,601.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,901.90
|
| Rate for Payer: Quartz Beloit One Network |
$880.88
|
| Rate for Payer: Quartz Commercial |
$1,141.14
|
| Rate for Payer: The Alliance Commercial |
$1,001.00
|
| Rate for Payer: United Healthcare Medicaid |
$602.65
|
| Rate for Payer: WEA Trust Commercial |
$1,101.10
|
| Rate for Payer: WPS Commercial |
$1,482.88
|
|
