|
6FR SHEATH-55CM
|
Facility
OP
|
$1,408.00
|
|
| Hospital Charge Code |
6175141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.92
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
6FR SHEATH-70CM
|
Facility
IP
|
$1,585.00
|
|
| Hospital Charge Code |
6175140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.65 |
| Max. Negotiated Rate |
$1,458.20 |
| Rate for Payer: Aetna Commercial |
$1,426.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.05
|
| Rate for Payer: Cash Price |
$475.50
|
| Rate for Payer: Cigna Commercial |
$1,458.20
|
| Rate for Payer: Health EOS Commercial |
$1,410.65
|
| Rate for Payer: HFN Commercial |
$1,458.20
|
| Rate for Payer: Multiplan Commercial |
$1,268.00
|
| Rate for Payer: NAPHCARE Commercial |
$951.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.20
|
| Rate for Payer: Quartz Beloit One Network |
$776.65
|
| Rate for Payer: Quartz Commercial |
$951.00
|
| Rate for Payer: WEA Trust Commercial |
$871.75
|
| Rate for Payer: WPS Commercial |
$1,174.01
|
|
|
6FR SHEATH-70CM
|
Facility
OP
|
$1,585.00
|
|
| Hospital Charge Code |
6175140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.80 |
| Max. Negotiated Rate |
$6,340.00 |
| Rate for Payer: Aetna Commercial |
$1,426.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.10
|
| Rate for Payer: Aetna Managed Medicare |
$443.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.05
|
| Rate for Payer: Cash Price |
$475.50
|
| Rate for Payer: Cigna Commercial |
$1,458.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.65
|
| Rate for Payer: HFN Commercial |
$1,458.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.75
|
| Rate for Payer: Multiplan Commercial |
$1,268.00
|
| Rate for Payer: NAPHCARE Commercial |
$951.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.20
|
| Rate for Payer: Quartz Beloit One Network |
$776.65
|
| Rate for Payer: Quartz Commercial |
$1,030.25
|
| Rate for Payer: Quartz Medicare Advantage |
$951.00
|
| Rate for Payer: The Alliance Commercial |
$6,340.00
|
| Rate for Payer: WEA Trust Commercial |
$871.75
|
| Rate for Payer: WPS Commercial |
$1,174.01
|
|
|
6Fr Super Flex
|
Professional
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
6Fr Super Flex
|
Facility
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
6Fr Super Flex
|
Facility
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
6-Monoacetylmorphine, Urine
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
4598988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$425.68 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.96
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$131.30
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$151.50
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
6-Monoacetylmorphine, Urine
|
Facility
IP
|
$202.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
4598988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$185.84 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$121.20
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
6-Monoacetylmorphine, Urine
|
Professional
|
$202.00
|
|
|
Service Code
|
CPT 80356
|
| Hospital Charge Code |
4598988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$503.49 |
| Rate for Payer: Aetna Commercial |
$191.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$191.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$183.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$191.90
|
| Rate for Payer: Quartz Beloit One Network |
$88.88
|
| Rate for Payer: Quartz Commercial |
$115.14
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$503.49
|
|
|
7.5FR IAB-40cc
|
Facility
IP
|
$6,528.00
|
|
| Hospital Charge Code |
5184608
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,198.72 |
| Max. Negotiated Rate |
$6,005.76 |
| Rate for Payer: Aetna Commercial |
$5,875.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.84
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cigna Commercial |
$6,005.76
|
| Rate for Payer: Health EOS Commercial |
$5,809.92
|
| Rate for Payer: HFN Commercial |
$6,005.76
|
| Rate for Payer: Multiplan Commercial |
$5,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,005.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.72
|
| Rate for Payer: Quartz Commercial |
$3,916.80
|
| Rate for Payer: WEA Trust Commercial |
$3,590.40
|
| Rate for Payer: WPS Commercial |
$4,835.29
|
|
|
7.5FR IAB-40cc
|
Facility
OP
|
$6,528.00
|
|
| Hospital Charge Code |
5184608
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,827.84 |
| Max. Negotiated Rate |
$26,112.00 |
| Rate for Payer: Aetna Commercial |
$5,875.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,614.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,827.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,243.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,264.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,133.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,459.84
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cigna Commercial |
$6,005.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,653.07
|
| Rate for Payer: Health EOS Commercial |
$5,809.92
|
| Rate for Payer: HFN Commercial |
$6,005.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,896.00
|
| Rate for Payer: Multiplan Commercial |
$5,222.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,005.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,198.72
|
| Rate for Payer: Quartz Commercial |
$4,243.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,916.80
|
| Rate for Payer: The Alliance Commercial |
$26,112.00
|
| Rate for Payer: WEA Trust Commercial |
$3,590.40
|
| Rate for Payer: WPS Commercial |
$4,835.29
|
|
|
.76 DRILL BIT/MINI W/ 12MM STOP 316.292
|
Facility
OP
|
$2,187.00
|
|
| Hospital Charge Code |
2966170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$8,748.00 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.82
|
| Rate for Payer: Aetna Managed Medicare |
$612.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,421.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.11
|
| Rate for Payer: Cash Price |
$656.10
|
| Rate for Payer: Cigna Commercial |
$2,012.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.85
|
| Rate for Payer: Health EOS Commercial |
$1,946.43
|
| Rate for Payer: HFN Commercial |
$2,012.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,640.25
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.63
|
| Rate for Payer: Quartz Commercial |
$1,421.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,312.20
|
| Rate for Payer: The Alliance Commercial |
$8,748.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.85
|
| Rate for Payer: WPS Commercial |
$1,619.91
|
|
|
.76 DRILL BIT/MINI W/ 12MM STOP 316.292
|
Facility
IP
|
$2,187.00
|
|
| Hospital Charge Code |
2966170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,071.63 |
| Max. Negotiated Rate |
$2,012.04 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.11
|
| Rate for Payer: Cash Price |
$656.10
|
| Rate for Payer: Cigna Commercial |
$2,012.04
|
| Rate for Payer: Health EOS Commercial |
$1,946.43
|
| Rate for Payer: HFN Commercial |
$2,012.04
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.63
|
| Rate for Payer: Quartz Commercial |
$1,312.20
|
| Rate for Payer: WEA Trust Commercial |
$1,202.85
|
| Rate for Payer: WPS Commercial |
$1,619.91
|
|
|
7FR Superflex Sheath
|
Facility
OP
|
$532.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4528617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$489.44 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| Rate for Payer: Aetna Managed Medicare |
$148.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.71
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$345.80
|
| Rate for Payer: Quartz Medicare Advantage |
$319.20
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
7FR Superflex Sheath
|
Facility
IP
|
$532.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4528617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$489.44 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
80 mg - Firmagon Charge
|
Facility
IP
|
$748.00
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
6183043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
80 mg - Firmagon Charge
|
Facility
OP
|
$748.00
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
6183043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$5,962.40 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$4.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.04
|
| Rate for Payer: Anthem Medicare Advantage |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.19
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.19
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$6.28
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.19
|
| Rate for Payer: The Alliance Commercial |
$5,962.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.19
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: Wellcare Medicare |
$4.19
|
| Rate for Payer: WPS Commercial |
$10.88
|
|
|
80 mg - Firmagon Charge
|
Professional
|
$748.00
|
|
|
Service Code
|
HCPCS J9155
|
| Hospital Charge Code |
6183043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna Commercial |
$710.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$4.19
|
| Rate for Payer: Anthem Medicare Advantage |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.19
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$374.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.35
|
| Rate for Payer: Health EOS Commercial |
$680.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Preferred Network Access Commercial |
$710.60
|
| Rate for Payer: Quartz Beloit One Network |
$329.12
|
| Rate for Payer: Quartz Commercial |
$426.36
|
| Rate for Payer: Quartz Medicare Advantage |
$4.19
|
| Rate for Payer: The Alliance Commercial |
$11.53
|
| Rate for Payer: United Healthcare Medicaid |
$4.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.19
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$10.88
|
|
|
85103 AP Bill Bone Marrow Needle Bx
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
1034022
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
85103 AP Bill Bone Marrow Needle Bx
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
1034022
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
85535 AP Bill Iron Stain Bone Marrow (Smears)
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
1034021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
85535 AP Bill Iron Stain Bone Marrow (Smears)
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
1034021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$226.72 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| 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: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| 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: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
88104 AP Bill Non-Gyn Cytology
|
Facility
IP
|
$187.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
295380
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
88104 AP Bill Non-Gyn Cytology
|
Facility
OP
|
$187.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
295380
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.80
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
88106 AP Bill Cyto Non-Gyn Filter Method
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 88106
|
| Hospital Charge Code |
1034024
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
