|
REPAIR TONGUE LACERATION 41252
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
3014618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$909.15 |
| Rate for Payer: Aetna Commercial |
$909.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.02
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna Commercial |
$909.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$574.20
|
| Rate for Payer: Health EOS Commercial |
$870.87
|
| Rate for Payer: HFN Commercial |
$909.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$693.47
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$909.15
|
| Rate for Payer: Quartz Beloit One Network |
$421.08
|
| Rate for Payer: Quartz Commercial |
$545.49
|
| Rate for Payer: The Alliance Commercial |
$478.50
|
| Rate for Payer: United Healthcare Medicaid |
$164.33
|
| Rate for Payer: WEA Trust Commercial |
$526.35
|
| Rate for Payer: WPS Commercial |
$708.85
|
|
|
REPAIR UPPER JAW FISTULA 30580
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
CPT 30580
|
| Hospital Charge Code |
3014361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$512.11 |
| Max. Negotiated Rate |
$2,829.10 |
| Rate for Payer: Aetna Commercial |
$2,829.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,561.08
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$2,829.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,786.80
|
| Rate for Payer: Health EOS Commercial |
$2,709.98
|
| Rate for Payer: HFN Commercial |
$2,829.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,568.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,568.45
|
| Rate for Payer: Multiplan Commercial |
$2,382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,829.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,310.32
|
| Rate for Payer: Quartz Commercial |
$1,697.46
|
| Rate for Payer: The Alliance Commercial |
$1,489.00
|
| Rate for Payer: United Healthcare Medicaid |
$512.11
|
| Rate for Payer: WEA Trust Commercial |
$1,637.90
|
| Rate for Payer: WPS Commercial |
$2,205.80
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS 49450
|
Professional
|
Both
|
$3,177.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
6187349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.98 |
| Max. Negotiated Rate |
$3,018.15 |
| Rate for Payer: Aetna Commercial |
$3,018.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,732.22
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cigna Commercial |
$3,018.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$578.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,906.20
|
| Rate for Payer: Health EOS Commercial |
$2,891.07
|
| Rate for Payer: HFN Commercial |
$3,018.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.98
|
| Rate for Payer: Multiplan Commercial |
$2,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,018.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.88
|
| Rate for Payer: Quartz Commercial |
$1,810.89
|
| Rate for Payer: The Alliance Commercial |
$1,588.50
|
| Rate for Payer: United Healthcare Medicaid |
$578.64
|
| Rate for Payer: WEA Trust Commercial |
$1,747.35
|
| Rate for Payer: WPS Commercial |
$2,353.20
|
|
|
REPLACE G-J TUBE PERC 49452
|
Professional
|
Both
|
$2,016.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
3014888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna Commercial |
$1,915.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.76
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$1,915.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$750.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,209.60
|
| Rate for Payer: Health EOS Commercial |
$1,834.56
|
| Rate for Payer: HFN Commercial |
$1,915.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$461.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$461.16
|
| Rate for Payer: Multiplan Commercial |
$1,612.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,915.20
|
| Rate for Payer: Quartz Beloit One Network |
$887.04
|
| Rate for Payer: Quartz Commercial |
$1,149.12
|
| Rate for Payer: The Alliance Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Medicaid |
$750.20
|
| Rate for Payer: WEA Trust Commercial |
$1,108.80
|
| Rate for Payer: WPS Commercial |
$1,493.25
|
|
|
REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 36578
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 36581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
REPLACE TUNNELED CV CATH 36581
|
Professional
|
Both
|
$3,329.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3014535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$611.64 |
| Max. Negotiated Rate |
$3,162.55 |
| Rate for Payer: Aetna Commercial |
$3,162.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.94
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cigna Commercial |
$3,162.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,997.40
|
| Rate for Payer: Health EOS Commercial |
$3,029.39
|
| Rate for Payer: HFN Commercial |
$3,162.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.64
|
| Rate for Payer: Multiplan Commercial |
$2,663.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,162.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,464.76
|
| Rate for Payer: Quartz Commercial |
$1,897.53
|
| Rate for Payer: The Alliance Commercial |
$1,664.50
|
| Rate for Payer: United Healthcare Medicaid |
$613.48
|
| Rate for Payer: WEA Trust Commercial |
$1,830.95
|
| Rate for Payer: WPS Commercial |
$2,465.79
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
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
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
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
|
|
|
RESECT INFERIOR TURBINATE 30140
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
3014355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$588.24 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.00
|
| Rate for Payer: Health EOS Commercial |
$232.05
|
| Rate for Payer: HFN Commercial |
$242.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$588.24
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$242.25
|
| Rate for Payer: Quartz Beloit One Network |
$112.20
|
| Rate for Payer: Quartz Commercial |
$145.35
|
| Rate for Payer: The Alliance Commercial |
$127.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
Resect Inferior Turbinate 3014050
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 30140 50
|
| Hospital Charge Code |
3165679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.72 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Aetna Commercial |
$487.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$487.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.80
|
| Rate for Payer: Health EOS Commercial |
$466.83
|
| Rate for Payer: HFN Commercial |
$487.35
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$487.35
|
| Rate for Payer: Quartz Beloit One Network |
$225.72
|
| Rate for Payer: Quartz Commercial |
$292.41
|
| Rate for Payer: The Alliance Commercial |
$256.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
RESECTOR 3.5 FULL RADIUS C9248
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
2965529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
RESECTOR 3.5 FULL RADIUS C9248
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
2965529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.07
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$208.00
|
| Rate for Payer: Quartz Medicare Advantage |
$192.00
|
| Rate for Payer: The Alliance Commercial |
$1,280.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
RESERVOIR HARD-SHELL 150M CELL SAVER 205 00205-00
|
Facility
|
OP
|
$1,312.00
|
|
| Hospital Charge Code |
2962980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.36 |
| Max. Negotiated Rate |
$5,248.00 |
| Rate for Payer: Aetna Commercial |
$1,180.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.32
|
| Rate for Payer: Aetna Managed Medicare |
$367.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$852.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$656.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$629.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.36
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$1,207.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$734.20
|
| Rate for Payer: Health EOS Commercial |
$1,167.68
|
| Rate for Payer: HFN Commercial |
$1,207.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$984.00
|
| Rate for Payer: Multiplan Commercial |
$1,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.04
|
| Rate for Payer: Quartz Beloit One Network |
$642.88
|
| Rate for Payer: Quartz Commercial |
$852.80
|
| Rate for Payer: Quartz Medicare Advantage |
$787.20
|
| Rate for Payer: The Alliance Commercial |
$5,248.00
|
| Rate for Payer: WEA Trust Commercial |
$721.60
|
| Rate for Payer: WPS Commercial |
$971.80
|
|
|
RESERVOIR HARD-SHELL 150M CELL SAVER 205 00205-00
|
Facility
|
IP
|
$1,312.00
|
|
| Hospital Charge Code |
2962980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.88 |
| Max. Negotiated Rate |
$1,207.04 |
| Rate for Payer: Aetna Commercial |
$1,180.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,128.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$695.36
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$1,207.04
|
| Rate for Payer: Health EOS Commercial |
$1,167.68
|
| Rate for Payer: HFN Commercial |
$1,207.04
|
| Rate for Payer: Multiplan Commercial |
$1,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$787.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,207.04
|
| Rate for Payer: Quartz Beloit One Network |
$642.88
|
| Rate for Payer: Quartz Commercial |
$787.20
|
| Rate for Payer: WEA Trust Commercial |
$721.60
|
| Rate for Payer: WPS Commercial |
$971.80
|
|
|
Respiratory Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Respiratory Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Respiratory Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$26,553.00
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$9,551.37 |
| Max. Negotiated Rate |
$26,553.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,551.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,551.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,551.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,551.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,551.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,551.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,240.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,551.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,551.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,551.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,551.37
|
| Rate for Payer: NAPHCARE Commercial |
$14,327.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,551.37
|
| Rate for Payer: The Alliance Commercial |
$26,553.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,551.37
|
| Rate for Payer: United Healthcare PPO |
$14,979.09
|
| Rate for Payer: Wellcare Medicare |
$9,551.37
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$45,421.00
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$16,338.44 |
| Max. Negotiated Rate |
$45,421.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,338.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,666.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,337.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,972.60
|
| Rate for Payer: Anthem Medicare Advantage |
$16,338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,338.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,338.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,831.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,338.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,079.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,338.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,338.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,338.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,338.44
|
| Rate for Payer: NAPHCARE Commercial |
$24,507.66
|
| Rate for Payer: Quartz Medicare Advantage |
$16,338.44
|
| Rate for Payer: The Alliance Commercial |
$45,421.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,338.44
|
| Rate for Payer: United Healthcare PPO |
$25,753.05
|
| Rate for Payer: Wellcare Medicare |
$16,338.44
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,614.00
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$7,414.93 |
| Max. Negotiated Rate |
$20,614.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,414.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,221.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,611.28
|
| Rate for Payer: Anthem Medicare Advantage |
$7,414.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,414.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,414.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,414.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,889.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,414.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,884.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,414.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,414.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,414.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,414.93
|
| Rate for Payer: NAPHCARE Commercial |
$11,122.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,414.93
|
| Rate for Payer: The Alliance Commercial |
$20,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,414.93
|
| Rate for Payer: United Healthcare PPO |
$11,587.66
|
| Rate for Payer: Wellcare Medicare |
$7,414.93
|
|
|
Respiratory Motion Management Simulation
|
Facility
|
OP
|
$3,137.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
3970754
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$878.36 |
| Max. Negotiated Rate |
$12,548.00 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Aetna Managed Medicare |
$878.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,505.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.47
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,352.75
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$2,039.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.20
|
| Rate for Payer: The Alliance Commercial |
$12,548.00
|
| Rate for Payer: United Healthcare PPO |
$2,352.75
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
Respiratory Motion Management Simulation
|
Facility
|
IP
|
$3,137.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
3970754
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,537.13 |
| Max. Negotiated Rate |
$2,886.04 |
| Rate for Payer: Aetna Commercial |
$2,823.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,697.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.61
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$2,886.04
|
| Rate for Payer: Health EOS Commercial |
$2,791.93
|
| Rate for Payer: HFN Commercial |
$2,886.04
|
| Rate for Payer: Multiplan Commercial |
$2,509.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.13
|
| Rate for Payer: Quartz Commercial |
$1,882.20
|
| Rate for Payer: WEA Trust Commercial |
$1,725.35
|
| Rate for Payer: WPS Commercial |
$2,323.58
|
|
|
Respiratory Motion Management Simulation 7729326
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
CPT 77293 26
|
| Hospital Charge Code |
5518682
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$361.01 |
| Max. Negotiated Rate |
$816.05 |
| Rate for Payer: Aetna Commercial |
$816.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.74
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$816.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$429.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.40
|
| Rate for Payer: Health EOS Commercial |
$781.69
|
| Rate for Payer: HFN Commercial |
$816.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$361.01
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.05
|
| Rate for Payer: Quartz Beloit One Network |
$377.96
|
| Rate for Payer: Quartz Commercial |
$489.63
|
| Rate for Payer: The Alliance Commercial |
$429.50
|
| Rate for Payer: WEA Trust Commercial |
$472.45
|
| Rate for Payer: WPS Commercial |
$636.26
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$29,594.00
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$10,645.40 |
| Max. Negotiated Rate |
$29,594.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,645.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,078.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,689.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,805.80
|
| Rate for Payer: Anthem Medicare Advantage |
$10,645.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,645.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,645.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,645.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,655.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,645.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,471.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,645.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,645.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,645.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,645.40
|
| Rate for Payer: NAPHCARE Commercial |
$15,968.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,645.40
|
| Rate for Payer: The Alliance Commercial |
$29,594.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,645.40
|
| Rate for Payer: United Healthcare PPO |
$16,715.80
|
| Rate for Payer: Wellcare Medicare |
$10,645.40
|
|
