|
ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 50390
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
|
|
ASPIRATION EXPORT 6FR
|
Facility
|
IP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,052.50 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$3,737.76
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ASPIRATION EXPORT 6FR
|
Facility
|
OP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,744.29 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,744.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,049.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,114.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,990.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,486.18
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,672.20
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: NAPHCARE Commercial |
$3,737.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$4,049.24
|
| Rate for Payer: Quartz Medicare Advantage |
$3,737.76
|
| Rate for Payer: The Alliance Commercial |
$3,114.80
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ASPIRATION EXPORT 7FR
|
Facility
|
IP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,052.50 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$3,737.76
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ASPIRATION EXPORT 7FR
|
Facility
|
OP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,744.29 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,744.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,049.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,114.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,990.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,486.18
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,672.20
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: NAPHCARE Commercial |
$3,737.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$4,049.24
|
| Rate for Payer: Quartz Medicare Advantage |
$3,737.76
|
| Rate for Payer: The Alliance Commercial |
$3,114.80
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ASPIRATION NEEDLE DISP 21G
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.52 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$878.59
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
ASPIRATION NEEDLE DISP 21G
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
Aspiration or Injection of Ganglion Cyst 20612
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
1188963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$35.57
|
| Rate for Payer: Anthem Medicare Advantage |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.57
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.57
|
| Rate for Payer: Health EOS Commercial |
$256.47
|
| Rate for Payer: HFN Commercial |
$267.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.57
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$53.35
|
| Rate for Payer: Preferred Network Access Commercial |
$267.75
|
| Rate for Payer: Quartz Beloit One Network |
$124.01
|
| Rate for Payer: Quartz Commercial |
$160.65
|
| Rate for Payer: Quartz Medicare Advantage |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$151.16
|
| Rate for Payer: United Healthcare Medicaid |
$51.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$160.06
|
|
|
ASPIRATOR MECONIUM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS A4628
|
| Hospital Charge Code |
2963172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
ASPIRATOR MECONIUM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS A4628
|
| Hospital Charge Code |
2963172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Aspir/Inj Major 20611 - Admin Intra-articular Injection Charge
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
4510910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$841.86 |
| Max. Negotiated Rate |
$1,580.63 |
| Rate for Payer: Aetna Commercial |
$1,546.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,477.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$910.58
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$1,580.63
|
| Rate for Payer: Health EOS Commercial |
$1,529.09
|
| Rate for Payer: HFN Commercial |
$1,580.63
|
| Rate for Payer: Multiplan Commercial |
$1,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,580.63
|
| Rate for Payer: Quartz Beloit One Network |
$841.86
|
| Rate for Payer: Quartz Commercial |
$1,030.85
|
| Rate for Payer: WEA Trust Commercial |
$944.94
|
| Rate for Payer: WPS Commercial |
$1,272.54
|
|
|
Aspir/Inj Major 20611 - Admin Intra-articular Injection Charge
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
4510910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$1,173.74 |
| Rate for Payer: Aetna Commercial |
$1,173.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$48.32
|
| Rate for Payer: Anthem Medicare Advantage |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.32
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,173.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.32
|
| Rate for Payer: Health EOS Commercial |
$1,124.32
|
| Rate for Payer: HFN Commercial |
$1,173.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.32
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$72.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.74
|
| Rate for Payer: Quartz Beloit One Network |
$543.63
|
| Rate for Payer: Quartz Commercial |
$704.25
|
| Rate for Payer: Quartz Medicare Advantage |
$48.32
|
| Rate for Payer: The Alliance Commercial |
$205.35
|
| Rate for Payer: United Healthcare Medicaid |
$72.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.32
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$217.43
|
|
|
Aspir/Inj Major 20611 - Admin Intra-articular Injection Charge
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
4510910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$323.03 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,546.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,477.55
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,116.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$859.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$824.68
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$910.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$1,580.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$1,529.09
|
| Rate for Payer: HFN Commercial |
$1,580.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$1,374.46
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,580.63
|
| Rate for Payer: Quartz Beloit One Network |
$841.86
|
| Rate for Payer: Quartz Commercial |
$1,116.75
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: WEA Trust Commercial |
$944.94
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$1,272.54
|
|
|
ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ - BILAT 5039050
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
CPT 50390 50
|
| Hospital Charge Code |
6172493
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$1,672.68 |
| Rate for Payer: Aetna Commercial |
$1,672.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,514.22
|
| Rate for Payer: Cash Price |
$507.90
|
| Rate for Payer: Cash Price |
$507.90
|
| Rate for Payer: Cash Price |
$507.90
|
| Rate for Payer: Cigna Commercial |
$1,672.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,056.43
|
| Rate for Payer: Health EOS Commercial |
$1,602.26
|
| Rate for Payer: HFN Commercial |
$1,672.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$333.53
|
| Rate for Payer: Multiplan Commercial |
$1,408.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,672.68
|
| Rate for Payer: Quartz Beloit One Network |
$774.72
|
| Rate for Payer: Quartz Commercial |
$1,003.61
|
| Rate for Payer: The Alliance Commercial |
$880.36
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: WEA Trust Commercial |
$968.40
|
| Rate for Payer: WPS Commercial |
$1,304.12
|
|
|
Assessment of Hearing Aid
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS V5010
|
| Hospital Charge Code |
3243550
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
Assessment of Hearing Aid
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS V5010
|
| Hospital Charge Code |
3243550
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Aetna Managed Medicare |
$88.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.90
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$190.32
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| Rate for Payer: Quartz Medicare Advantage |
$190.32
|
| Rate for Payer: The Alliance Commercial |
$158.60
|
| Rate for Payer: United Healthcare PPO |
$237.90
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
Assessment of Hearing Aid
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS V5010
|
| Hospital Charge Code |
3243550
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$139.57 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.32
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.60
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| Rate for Payer: The Alliance Commercial |
$158.60
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
Assessment Of Tinnitus
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 92625
|
| Hospital Charge Code |
3203481
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$102.34
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
Assessment Of Tinnitus
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 92625
|
| Hospital Charge Code |
3203481
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.87
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
Assessment Of Tinnitus
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
CPT 92625
|
| Hospital Charge Code |
3203481
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna Commercial |
$162.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$50.48
|
| Rate for Payer: Anthem Medicare Advantage |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.48
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$162.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.48
|
| Rate for Payer: Health EOS Commercial |
$155.21
|
| Rate for Payer: HFN Commercial |
$162.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.48
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$75.72
|
| Rate for Payer: Preferred Network Access Commercial |
$162.03
|
| Rate for Payer: Quartz Beloit One Network |
$75.05
|
| Rate for Payer: Quartz Commercial |
$97.22
|
| Rate for Payer: Quartz Medicare Advantage |
$50.48
|
| Rate for Payer: The Alliance Commercial |
$126.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.48
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$201.93
|
|
|
AST (FS)
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
4538806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$4.73
|
| Rate for Payer: HFN Commercial |
$4.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4.94
|
| Rate for Payer: Quartz Beloit One Network |
$2.29
|
| Rate for Payer: Quartz Commercial |
$2.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
AST (FS)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
4538806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$3.90
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
AST (FS)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
4538806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ASTHMA
|
Facility
|
IP
|
$3,945.74
|
|
|
Service Code
|
APR-DRG 1411
|
| Min. Negotiated Rate |
$3,504.85 |
| Max. Negotiated Rate |
$3,945.74 |
| Rate for Payer: Anthem Medicaid |
$3,778.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,778.26
|
| Rate for Payer: Dean Health Medicaid |
$3,778.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,504.85
|
| Rate for Payer: Managed Health Services Medicaid |
$3,945.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,778.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,778.26
|
| Rate for Payer: United Healthcare Medicaid |
$3,778.26
|
|
