|
Subsequent Hospital Care 99232
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
4001097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Subsequent Hospital Care 99232
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 99232
|
| Hospital Charge Code |
4001097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$100.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.46
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: Quartz Medicare Advantage |
$216.00
|
| Rate for Payer: The Alliance Commercial |
$1,440.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Subsequent Hospital Care 99233
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
4001098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$318.50
|
| Rate for Payer: Quartz Medicare Advantage |
$294.00
|
| Rate for Payer: The Alliance Commercial |
$1,960.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
Subsequent Hospital Care 99233
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 99233
|
| Hospital Charge Code |
4001098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.10 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$450.80
|
| Rate for Payer: Health EOS Commercial |
$436.10
|
| Rate for Payer: HFN Commercial |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: NAPHCARE Commercial |
$294.00
|
| Rate for Payer: Preferred Network Access Commercial |
$450.80
|
| Rate for Payer: Quartz Beloit One Network |
$240.10
|
| Rate for Payer: Quartz Commercial |
$294.00
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
Subsequent Skilled Nursing Facility Low
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 99308
|
| Hospital Charge Code |
1122852
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$247.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.60
|
| Rate for Payer: Health EOS Commercial |
$237.51
|
| Rate for Payer: HFN Commercial |
$247.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.86
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$247.95
|
| Rate for Payer: Quartz Beloit One Network |
$114.84
|
| Rate for Payer: Quartz Commercial |
$148.77
|
| Rate for Payer: The Alliance Commercial |
$130.50
|
| Rate for Payer: United Healthcare Medicaid |
$47.50
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Subsequent Skilled Nursing Facility Minor
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 99307
|
| Hospital Charge Code |
1122851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.66
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.66
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
successful insertion femoral artery - Arterial Line Procedure Result:
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,436.00 |
| Rate for Payer: Aetna Commercial |
$1,223.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.74
|
| Rate for Payer: Aetna Managed Medicare |
$380.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$883.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$679.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$652.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.27
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,250.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,209.51
|
| Rate for Payer: HFN Commercial |
$1,250.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,019.25
|
| Rate for Payer: Multiplan Commercial |
$1,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$815.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,250.28
|
| Rate for Payer: Quartz Beloit One Network |
$665.91
|
| Rate for Payer: Quartz Commercial |
$883.35
|
| Rate for Payer: Quartz Medicare Advantage |
$815.40
|
| Rate for Payer: The Alliance Commercial |
$5,436.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$747.45
|
| Rate for Payer: WPS Commercial |
$1,006.61
|
|
|
successful insertion femoral artery - Arterial Line Procedure Result:
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.91 |
| Max. Negotiated Rate |
$1,250.28 |
| Rate for Payer: Aetna Commercial |
$1,223.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.27
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,250.28
|
| Rate for Payer: Health EOS Commercial |
$1,209.51
|
| Rate for Payer: HFN Commercial |
$1,250.28
|
| Rate for Payer: Multiplan Commercial |
$1,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$815.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,250.28
|
| Rate for Payer: Quartz Beloit One Network |
$665.91
|
| Rate for Payer: Quartz Commercial |
$815.40
|
| Rate for Payer: WEA Trust Commercial |
$747.45
|
| Rate for Payer: WPS Commercial |
$1,006.61
|
|
|
successful insertion femoral site - Central IV Procedure Result:
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025907
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$858.48 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,576.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.56
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$1,611.84
|
| Rate for Payer: Health EOS Commercial |
$1,559.28
|
| Rate for Payer: HFN Commercial |
$1,611.84
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.84
|
| Rate for Payer: Quartz Beloit One Network |
$858.48
|
| Rate for Payer: Quartz Commercial |
$1,051.20
|
| Rate for Payer: WEA Trust Commercial |
$963.60
|
| Rate for Payer: WPS Commercial |
$1,297.71
|
|
|
successful insertion femoral site - Central IV Procedure Result:
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025907
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$1,576.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.96
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cigna Commercial |
$1,611.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$1,559.28
|
| Rate for Payer: HFN Commercial |
$1,611.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$1,401.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.84
|
| Rate for Payer: Quartz Beloit One Network |
$858.48
|
| Rate for Payer: Quartz Commercial |
$1,138.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$963.60
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$1,297.71
|
|
|
successful insertion jugular site - Central IV Procedure Result:
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$944.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
successful insertion jugular site - Central IV Procedure Result:
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025906
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$711.97 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$871.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$871.80
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
successful insertion Opti Q catheter - PA Line Procedure Result
|
Facility
|
IP
|
$3,832.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025928
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,877.68 |
| Max. Negotiated Rate |
$3,525.44 |
| Rate for Payer: Aetna Commercial |
$3,448.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,295.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,030.96
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,525.44
|
| Rate for Payer: Health EOS Commercial |
$3,410.48
|
| Rate for Payer: HFN Commercial |
$3,525.44
|
| Rate for Payer: Multiplan Commercial |
$3,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,299.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,525.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.68
|
| Rate for Payer: Quartz Commercial |
$2,299.20
|
| Rate for Payer: WEA Trust Commercial |
$2,107.60
|
| Rate for Payer: WPS Commercial |
$2,838.36
|
|
|
successful insertion Opti Q catheter - PA Line Procedure Result
|
Facility
|
OP
|
$3,832.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025928
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$3,448.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,295.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,030.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cash Price |
$1,149.60
|
| Rate for Payer: Cigna Commercial |
$3,525.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,144.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$3,410.48
|
| Rate for Payer: HFN Commercial |
$3,525.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$3,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,525.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.68
|
| Rate for Payer: Quartz Commercial |
$2,490.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,107.60
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$2,838.36
|
|
|
successful insertion pacing Swan-Ganz catheter - PA Line Procedure Result
|
Facility
|
OP
|
$532.00
|
|
| Hospital Charge Code |
3025927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$2,128.00 |
| 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: The Alliance Commercial |
$2,128.00
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
successful insertion pacing Swan-Ganz catheter - PA Line Procedure Result
|
Facility
|
IP
|
$532.00
|
|
| Hospital Charge Code |
3025927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$489.44 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| 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
|
|
|
successful insertion radial artery - Arterial Line Procedure Result:
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005241
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$665.91 |
| Max. Negotiated Rate |
$1,250.28 |
| Rate for Payer: Aetna Commercial |
$1,223.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.27
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,250.28
|
| Rate for Payer: Health EOS Commercial |
$1,209.51
|
| Rate for Payer: HFN Commercial |
$1,250.28
|
| Rate for Payer: Multiplan Commercial |
$1,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$815.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,250.28
|
| Rate for Payer: Quartz Beloit One Network |
$665.91
|
| Rate for Payer: Quartz Commercial |
$815.40
|
| Rate for Payer: WEA Trust Commercial |
$747.45
|
| Rate for Payer: WPS Commercial |
$1,006.61
|
|
|
successful insertion radial artery - Arterial Line Procedure Result:
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
3005241
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$380.52 |
| Max. Negotiated Rate |
$5,436.00 |
| Rate for Payer: Aetna Commercial |
$1,223.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.74
|
| Rate for Payer: Aetna Managed Medicare |
$380.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$883.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$679.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$652.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$720.27
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cash Price |
$407.70
|
| Rate for Payer: Cigna Commercial |
$1,250.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,209.51
|
| Rate for Payer: HFN Commercial |
$1,250.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,019.25
|
| Rate for Payer: Multiplan Commercial |
$1,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$815.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,250.28
|
| Rate for Payer: Quartz Beloit One Network |
$665.91
|
| Rate for Payer: Quartz Commercial |
$883.35
|
| Rate for Payer: Quartz Medicare Advantage |
$815.40
|
| Rate for Payer: The Alliance Commercial |
$5,436.00
|
| Rate for Payer: United Healthcare PPO |
$1,019.25
|
| Rate for Payer: WEA Trust Commercial |
$747.45
|
| Rate for Payer: WPS Commercial |
$1,006.61
|
|
|
successful insertion subclavian site - Central IV Procedure Result:
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$711.97 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$871.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$871.80
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
successful insertion subclavian site - Central IV Procedure Result:
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3025905
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$944.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
successful insertion thermodilution catheter - PA Line Procedure Result
|
Facility
|
OP
|
$1,778.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025926
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$871.22 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$1,600.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,635.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,582.42
|
| Rate for Payer: HFN Commercial |
$1,635.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.76
|
| Rate for Payer: Quartz Beloit One Network |
$871.22
|
| Rate for Payer: Quartz Commercial |
$1,155.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$977.90
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,316.96
|
|
|
successful insertion thermodilution catheter - PA Line Procedure Result
|
Facility
|
IP
|
$1,778.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
3025926
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$871.22 |
| Max. Negotiated Rate |
$1,635.76 |
| Rate for Payer: Aetna Commercial |
$1,600.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.34
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,635.76
|
| Rate for Payer: Health EOS Commercial |
$1,582.42
|
| Rate for Payer: HFN Commercial |
$1,635.76
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.76
|
| Rate for Payer: Quartz Beloit One Network |
$871.22
|
| Rate for Payer: Quartz Commercial |
$1,066.80
|
| Rate for Payer: WEA Trust Commercial |
$977.90
|
| Rate for Payer: WPS Commercial |
$1,316.96
|
|
|
SUCKER MINI 1/4 IN X 9 IN SOFT TIP WITH SIDE PORTS TERUMO 14991S
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
2965160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SUCKER MINI 1/4 IN X 9 IN SOFT TIP WITH SIDE PORTS TERUMO 14991S
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
2965160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
SUCTION 1000ccEVAC CON.1614-05
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
2963569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$34.80
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
