|
ASTHMA
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 1413
|
| Min. Negotiated Rate |
$6,931.82 |
| Max. Negotiated Rate |
$7,803.80 |
| Rate for Payer: Anthem Medicaid |
$7,472.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,472.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,472.56
|
| Rate for Payer: Dean Health Medicaid |
$7,472.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,931.82
|
| Rate for Payer: Managed Health Services Medicaid |
$7,803.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,472.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,472.56
|
| Rate for Payer: United Healthcare Medicaid |
$7,472.56
|
|
|
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
|
|
|
ASTHMA
|
Facility
|
OP
|
$117.93
|
|
|
Service Code
|
EAPG 00575
|
| Min. Negotiated Rate |
$113.39 |
| Max. Negotiated Rate |
$117.93 |
| Rate for Payer: Anthem Medicaid |
$113.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$113.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.39
|
| Rate for Payer: Dean Health Medicaid |
$113.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$113.39
|
| Rate for Payer: Managed Health Services Medicaid |
$117.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$113.39
|
| Rate for Payer: United Healthcare Medicaid |
$113.39
|
|
|
ASTHMA
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 1412
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
Atherec/Stent/PTA Tib/Peroneal Ea Add +
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
3052456
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,345.34 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$4,324.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,132.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,402.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.54
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$4,420.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$4,276.27
|
| Rate for Payer: HFN Commercial |
$4,420.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,603.60
|
| Rate for Payer: Multiplan Commercial |
$3,843.84
|
| Rate for Payer: NAPHCARE Commercial |
$2,882.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,420.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.35
|
| Rate for Payer: Quartz Commercial |
$3,123.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2,882.88
|
| Rate for Payer: The Alliance Commercial |
$2,402.40
|
| Rate for Payer: WEA Trust Commercial |
$2,642.64
|
| Rate for Payer: WPS Commercial |
$3,558.79
|
|
|
Atherec/Stent/PTA Tib/Peroneal Ea Add +
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
3052456
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,354.35 |
| Max. Negotiated Rate |
$4,420.42 |
| Rate for Payer: Aetna Commercial |
$4,324.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,132.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.54
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cigna Commercial |
$4,420.42
|
| Rate for Payer: Health EOS Commercial |
$4,276.27
|
| Rate for Payer: HFN Commercial |
$4,420.42
|
| Rate for Payer: Multiplan Commercial |
$3,843.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,420.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.35
|
| Rate for Payer: Quartz Commercial |
$2,882.88
|
| Rate for Payer: WEA Trust Commercial |
$2,642.64
|
| Rate for Payer: WPS Commercial |
$3,558.79
|
|
|
Atherectomy Iliac, Ea.
|
Facility
|
IP
|
$26,231.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
5446677
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,367.32 |
| Max. Negotiated Rate |
$25,097.82 |
| Rate for Payer: Aetna Commercial |
$24,552.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,461.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,458.53
|
| Rate for Payer: Cash Price |
$7,869.30
|
| Rate for Payer: Cigna Commercial |
$25,097.82
|
| Rate for Payer: Health EOS Commercial |
$24,279.41
|
| Rate for Payer: HFN Commercial |
$25,097.82
|
| Rate for Payer: Multiplan Commercial |
$21,824.19
|
| Rate for Payer: Preferred Network Access Commercial |
$25,097.82
|
| Rate for Payer: Quartz Beloit One Network |
$13,367.32
|
| Rate for Payer: Quartz Commercial |
$16,368.14
|
| Rate for Payer: WEA Trust Commercial |
$15,004.13
|
| Rate for Payer: WPS Commercial |
$20,205.74
|
|
|
Atherectomy Iliac, Ea.
|
Facility
|
OP
|
$26,231.00
|
|
|
Service Code
|
CPT 0238T
|
| Hospital Charge Code |
5446677
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,386.95 |
| Max. Negotiated Rate |
$77,168.08 |
| Rate for Payer: Aetna Commercial |
$24,552.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,461.01
|
| Rate for Payer: Aetna Managed Medicare |
$19,292.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,458.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,292.02
|
| Rate for Payer: Cash Price |
$7,869.30
|
| Rate for Payer: Cash Price |
$7,869.30
|
| Rate for Payer: Cash Price |
$7,869.30
|
| Rate for Payer: Cigna Commercial |
$25,097.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,292.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,292.02
|
| Rate for Payer: Health EOS Commercial |
$24,279.41
|
| Rate for Payer: HFN Commercial |
$25,097.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,766.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,292.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,292.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,292.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,292.02
|
| Rate for Payer: Multiplan Commercial |
$21,824.19
|
| Rate for Payer: NAPHCARE Commercial |
$28,938.03
|
| Rate for Payer: Preferred Network Access Commercial |
$25,097.82
|
| Rate for Payer: Quartz Beloit One Network |
$13,367.32
|
| Rate for Payer: Quartz Commercial |
$17,732.16
|
| Rate for Payer: Quartz Medicare Advantage |
$19,292.02
|
| Rate for Payer: The Alliance Commercial |
$77,168.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,292.02
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$15,004.13
|
| Rate for Payer: Wellcare Medicare |
$19,292.02
|
| Rate for Payer: WPS Commercial |
$20,205.74
|
|
|
Atherectomy Tib/Peroneal Ea Add Vessel +
|
Facility
|
OP
|
$3,682.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
3052454
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,072.20 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,446.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,293.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,072.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,489.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,914.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,838.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.52
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cigna Commercial |
$3,522.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$3,408.06
|
| Rate for Payer: HFN Commercial |
$3,522.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,871.96
|
| Rate for Payer: Multiplan Commercial |
$3,063.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,297.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,522.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.35
|
| Rate for Payer: Quartz Commercial |
$2,489.03
|
| Rate for Payer: Quartz Medicare Advantage |
$2,297.57
|
| Rate for Payer: The Alliance Commercial |
$1,914.64
|
| Rate for Payer: WEA Trust Commercial |
$2,106.10
|
| Rate for Payer: WPS Commercial |
$2,836.24
|
|
|
Atherectomy Tib/Peroneal Ea Add Vessel +
|
Facility
|
IP
|
$3,682.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
3052454
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,876.35 |
| Max. Negotiated Rate |
$3,522.94 |
| Rate for Payer: Aetna Commercial |
$3,446.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,293.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.52
|
| Rate for Payer: Cash Price |
$1,104.60
|
| Rate for Payer: Cigna Commercial |
$3,522.94
|
| Rate for Payer: Health EOS Commercial |
$3,408.06
|
| Rate for Payer: HFN Commercial |
$3,522.94
|
| Rate for Payer: Multiplan Commercial |
$3,063.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,522.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.35
|
| Rate for Payer: Quartz Commercial |
$2,297.57
|
| Rate for Payer: WEA Trust Commercial |
$2,106.10
|
| Rate for Payer: WPS Commercial |
$2,836.24
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$31,331.04
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$9,670.59 |
| Max. Negotiated Rate |
$31,331.04 |
| Rate for Payer: Aetna Managed Medicare |
$9,670.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,108.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,012.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,012.92
|
| Rate for Payer: Anthem Medicare Advantage |
$9,670.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,670.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,670.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,670.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,106.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,670.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,735.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,670.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,670.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,670.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,670.59
|
| Rate for Payer: NAPHCARE Commercial |
$14,505.88
|
| Rate for Payer: Quartz Medicare Advantage |
$9,670.59
|
| Rate for Payer: The Alliance Commercial |
$31,331.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,670.59
|
| Rate for Payer: United Healthcare PPO |
$17,700.20
|
| Rate for Payer: Wellcare Medicare |
$9,670.59
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$18,529.68
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$5,662.27 |
| Max. Negotiated Rate |
$18,529.68 |
| Rate for Payer: Aetna Managed Medicare |
$5,662.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,688.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,258.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,696.56
|
| Rate for Payer: Anthem Medicare Advantage |
$5,662.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,662.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,662.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,662.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,662.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,346.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,662.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,662.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,662.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,662.27
|
| Rate for Payer: NAPHCARE Commercial |
$8,493.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,662.27
|
| Rate for Payer: The Alliance Commercial |
$18,529.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,662.27
|
| Rate for Payer: United Healthcare PPO |
$10,390.24
|
| Rate for Payer: Wellcare Medicare |
$5,662.27
|
|
|
Athrec/Stent/PTA Fem/Pop
|
Facility
|
IP
|
$9,758.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
3052448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,972.68 |
| Max. Negotiated Rate |
$9,336.45 |
| Rate for Payer: Aetna Commercial |
$9,133.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,727.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,378.61
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cigna Commercial |
$9,336.45
|
| Rate for Payer: Health EOS Commercial |
$9,032.00
|
| Rate for Payer: HFN Commercial |
$9,336.45
|
| Rate for Payer: Multiplan Commercial |
$8,118.66
|
| Rate for Payer: Preferred Network Access Commercial |
$9,336.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,972.68
|
| Rate for Payer: Quartz Commercial |
$6,088.99
|
| Rate for Payer: WEA Trust Commercial |
$5,581.58
|
| Rate for Payer: WPS Commercial |
$7,516.59
|
|
|
Athrec/Stent/PTA Fem/Pop
|
Facility
|
OP
|
$9,758.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
3052448
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,841.53 |
| Max. Negotiated Rate |
$20,607.60 |
| Rate for Payer: Aetna Commercial |
$9,133.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,727.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,841.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,378.61
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cigna Commercial |
$9,336.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$9,032.00
|
| Rate for Payer: HFN Commercial |
$9,336.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,611.24
|
| Rate for Payer: Multiplan Commercial |
$8,118.66
|
| Rate for Payer: NAPHCARE Commercial |
$6,088.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,336.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,972.68
|
| Rate for Payer: Quartz Commercial |
$6,596.41
|
| Rate for Payer: Quartz Medicare Advantage |
$6,088.99
|
| Rate for Payer: The Alliance Commercial |
$5,074.16
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$5,581.58
|
| Rate for Payer: WPS Commercial |
$7,516.59
|
|
|
Athrec/Stent/PTA Tib/Peroneal
|
Facility
|
OP
|
$10,527.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3052452
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,065.46 |
| Max. Negotiated Rate |
$20,607.60 |
| Rate for Payer: Aetna Commercial |
$9,853.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,415.35
|
| Rate for Payer: Aetna Managed Medicare |
$3,065.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.48
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cigna Commercial |
$10,072.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$9,743.79
|
| Rate for Payer: HFN Commercial |
$10,072.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,211.06
|
| Rate for Payer: Multiplan Commercial |
$8,758.46
|
| Rate for Payer: NAPHCARE Commercial |
$6,568.85
|
| Rate for Payer: Preferred Network Access Commercial |
$10,072.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,364.56
|
| Rate for Payer: Quartz Commercial |
$7,116.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6,568.85
|
| Rate for Payer: The Alliance Commercial |
$5,474.04
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$6,021.44
|
| Rate for Payer: WPS Commercial |
$8,108.95
|
|
|
Athrec/Stent/PTA Tib/Peroneal
|
Facility
|
IP
|
$10,527.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3052452
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,364.56 |
| Max. Negotiated Rate |
$10,072.23 |
| Rate for Payer: Aetna Commercial |
$9,853.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,415.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.48
|
| Rate for Payer: Cash Price |
$3,158.10
|
| Rate for Payer: Cigna Commercial |
$10,072.23
|
| Rate for Payer: Health EOS Commercial |
$9,743.79
|
| Rate for Payer: HFN Commercial |
$10,072.23
|
| Rate for Payer: Multiplan Commercial |
$8,758.46
|
| Rate for Payer: Preferred Network Access Commercial |
$10,072.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,364.56
|
| Rate for Payer: Quartz Commercial |
$6,568.85
|
| Rate for Payer: WEA Trust Commercial |
$6,021.44
|
| Rate for Payer: WPS Commercial |
$8,108.95
|
|
|
Athrectomy Fem/Pop incl PTA
|
Facility
|
OP
|
$9,110.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
3052446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,652.83 |
| Max. Negotiated Rate |
$19,394.96 |
| Rate for Payer: Aetna Commercial |
$8,526.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,147.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,652.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,021.43
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cigna Commercial |
$8,716.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$8,432.22
|
| Rate for Payer: HFN Commercial |
$8,716.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,105.80
|
| Rate for Payer: Multiplan Commercial |
$7,579.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,684.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,716.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,642.46
|
| Rate for Payer: Quartz Commercial |
$6,158.36
|
| Rate for Payer: Quartz Medicare Advantage |
$5,684.64
|
| Rate for Payer: The Alliance Commercial |
$4,737.20
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$5,210.92
|
| Rate for Payer: WPS Commercial |
$7,017.43
|
|
|
Athrectomy Fem/Pop incl PTA
|
Facility
|
IP
|
$9,110.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
3052446
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,642.46 |
| Max. Negotiated Rate |
$8,716.45 |
| Rate for Payer: Aetna Commercial |
$8,526.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,021.43
|
| Rate for Payer: Cash Price |
$2,733.00
|
| Rate for Payer: Cigna Commercial |
$8,716.45
|
| Rate for Payer: Health EOS Commercial |
$8,432.22
|
| Rate for Payer: HFN Commercial |
$8,716.45
|
| Rate for Payer: Multiplan Commercial |
$7,579.52
|
| Rate for Payer: Preferred Network Access Commercial |
$8,716.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,642.46
|
| Rate for Payer: Quartz Commercial |
$5,684.64
|
| Rate for Payer: WEA Trust Commercial |
$5,210.92
|
| Rate for Payer: WPS Commercial |
$7,017.43
|
|
|
Athrectomy Jetstream
|
Professional
|
Both
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,988.73 |
| Max. Negotiated Rate |
$4,293.85 |
| Rate for Payer: Aetna Commercial |
$4,293.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,293.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,259.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,711.90
|
| Rate for Payer: Health EOS Commercial |
$4,113.05
|
| Rate for Payer: HFN Commercial |
$4,293.85
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,293.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,988.73
|
| Rate for Payer: Quartz Commercial |
$2,576.31
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Athrectomy Jetstream
|
Facility
|
IP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,214.72 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,711.90
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Athrectomy Jetstream
|
Facility
|
OP
|
$4,346.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2550930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,265.56 |
| Max. Negotiated Rate |
$4,158.25 |
| Rate for Payer: Aetna Commercial |
$4,067.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,887.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,265.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,937.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,259.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,169.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,395.52
|
| Rate for Payer: Cash Price |
$1,303.80
|
| Rate for Payer: Cigna Commercial |
$4,158.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,529.37
|
| Rate for Payer: Health EOS Commercial |
$4,022.66
|
| Rate for Payer: HFN Commercial |
$4,158.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,389.88
|
| Rate for Payer: Multiplan Commercial |
$3,615.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,711.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,158.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,214.72
|
| Rate for Payer: Quartz Commercial |
$2,937.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,711.90
|
| Rate for Payer: The Alliance Commercial |
$2,259.92
|
| Rate for Payer: WEA Trust Commercial |
$2,485.91
|
| Rate for Payer: WPS Commercial |
$3,347.72
|
|
|
Athrectomy Tib/Peroneal Incl PTA
|
Facility
|
IP
|
$8,966.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3052450
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,569.07 |
| Max. Negotiated Rate |
$8,578.67 |
| Rate for Payer: Aetna Commercial |
$8,392.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,019.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,942.06
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cigna Commercial |
$8,578.67
|
| Rate for Payer: Health EOS Commercial |
$8,298.93
|
| Rate for Payer: HFN Commercial |
$8,578.67
|
| Rate for Payer: Multiplan Commercial |
$7,459.71
|
| Rate for Payer: Preferred Network Access Commercial |
$8,578.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,569.07
|
| Rate for Payer: Quartz Commercial |
$5,594.78
|
| Rate for Payer: WEA Trust Commercial |
$5,128.55
|
| Rate for Payer: WPS Commercial |
$6,906.51
|
|
|
Athrectomy Tib/Peroneal Incl PTA
|
Facility
|
OP
|
$8,966.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3052450
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,610.90 |
| Max. Negotiated Rate |
$20,607.60 |
| Rate for Payer: Aetna Commercial |
$8,392.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,019.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,610.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,942.06
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cash Price |
$2,689.80
|
| Rate for Payer: Cigna Commercial |
$8,578.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$8,298.93
|
| Rate for Payer: HFN Commercial |
$8,578.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,993.48
|
| Rate for Payer: Multiplan Commercial |
$7,459.71
|
| Rate for Payer: NAPHCARE Commercial |
$5,594.78
|
| Rate for Payer: Preferred Network Access Commercial |
$8,578.67
|
| Rate for Payer: Quartz Beloit One Network |
$4,569.07
|
| Rate for Payer: Quartz Commercial |
$6,061.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,594.78
|
| Rate for Payer: The Alliance Commercial |
$4,662.32
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$5,128.55
|
| Rate for Payer: WPS Commercial |
$6,906.51
|
|
|
Ativan 2 mg Charge
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$9.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.32
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$21.22
|
| Rate for Payer: The Alliance Commercial |
$5.87
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$2.50
|
|
|
Ativan 2 mg Charge
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
