|
Upp ext fx orthosis humeral L3980
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$1,297.51 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$450.00
|
| Rate for Payer: Anthem Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$450.00
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.00
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,297.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,297.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$675.00
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$450.00
|
| Rate for Payer: The Alliance Commercial |
$1,237.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$787.50
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$1,799.99 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$72.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$154.75
|
| Rate for Payer: The Alliance Commercial |
$1,799.99
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS 43235
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
3014654
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,562.03 |
| Rate for Payer: Aetna Commercial |
$1,562.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,562.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,496.26
|
| Rate for Payer: HFN Commercial |
$1,562.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.03
|
| Rate for Payer: Quartz Beloit One Network |
$723.47
|
| Rate for Payer: Quartz Commercial |
$937.22
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$457.74
|
| Rate for Payer: United Healthcare Medicaid |
$270.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$484.66
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS, EXTENDED 4323522
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
CPT 43235 22
|
| Hospital Charge Code |
6175703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.82 |
| Max. Negotiated Rate |
$1,874.24 |
| Rate for Payer: Aetna Commercial |
$1,874.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,874.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.73
|
| Rate for Payer: Health EOS Commercial |
$1,795.32
|
| Rate for Payer: HFN Commercial |
$1,874.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.64
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,874.24
|
| Rate for Payer: Quartz Beloit One Network |
$868.07
|
| Rate for Payer: Quartz Commercial |
$1,124.54
|
| Rate for Payer: The Alliance Commercial |
$986.44
|
| Rate for Payer: United Healthcare Medicaid |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
Urea Nitrogen 24 Hour Urine
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$25.44
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Urea Nitrogen, PDI Fluid
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: Aetna Commercial |
$65.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$65.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$62.46
|
| Rate for Payer: HFN Commercial |
$65.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$65.21
|
| Rate for Payer: Quartz Beloit One Network |
$30.20
|
| Rate for Payer: Quartz Commercial |
$39.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$18.08
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: United Healthcare PPO |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: Wellcare Medicare |
$4.11
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Urea Nitrogen Urine
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$4.11
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Urea Nitrogen Urine
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$18.08
|
|
|
Urea Nitrogen Urine
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Urea Nitrogen, Urine
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Urea Nitrogen, Urine
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$25.44
|
|
|
Urea Nitrogen, Urine
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Urea Nitrogen, Urine, PDI
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$25.44
|
|
|
Urea Nitrogen, Urine, PDI
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Urea Nitrogen, Urine, PDI
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 28MM M0062502000
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$1,538.53 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,438.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$886.33
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,538.53
|
| Rate for Payer: Health EOS Commercial |
$1,488.36
|
| Rate for Payer: HFN Commercial |
$1,538.53
|
| Rate for Payer: Multiplan Commercial |
$1,337.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,538.53
|
| Rate for Payer: Quartz Beloit One Network |
$819.44
|
| Rate for Payer: Quartz Commercial |
$1,003.39
|
| Rate for Payer: WEA Trust Commercial |
$919.78
|
| Rate for Payer: WPS Commercial |
$1,238.64
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 28MM M0062502000
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.25 |
| Max. Negotiated Rate |
$1,538.53 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,438.20
|
| Rate for Payer: Aetna Managed Medicare |
$468.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,087.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$836.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$802.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$886.33
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,538.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$935.86
|
| Rate for Payer: Health EOS Commercial |
$1,488.36
|
| Rate for Payer: HFN Commercial |
$1,538.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,254.24
|
| Rate for Payer: Multiplan Commercial |
$1,337.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,003.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,538.53
|
| Rate for Payer: Quartz Beloit One Network |
$819.44
|
| Rate for Payer: Quartz Commercial |
$1,087.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,003.39
|
| Rate for Payer: The Alliance Commercial |
$836.16
|
| Rate for Payer: WEA Trust Commercial |
$919.78
|
| Rate for Payer: WPS Commercial |
$1,238.64
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 46MM M0062502040
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$819.44 |
| Max. Negotiated Rate |
$1,538.53 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,438.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$886.33
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,538.53
|
| Rate for Payer: Health EOS Commercial |
$1,488.36
|
| Rate for Payer: HFN Commercial |
$1,538.53
|
| Rate for Payer: Multiplan Commercial |
$1,337.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,538.53
|
| Rate for Payer: Quartz Beloit One Network |
$819.44
|
| Rate for Payer: Quartz Commercial |
$1,003.39
|
| Rate for Payer: WEA Trust Commercial |
$919.78
|
| Rate for Payer: WPS Commercial |
$1,238.64
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 46MM M0062502040
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.25 |
| Max. Negotiated Rate |
$1,538.53 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,438.20
|
| Rate for Payer: Aetna Managed Medicare |
$468.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,087.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$836.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$802.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$886.33
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,538.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$935.86
|
| Rate for Payer: Health EOS Commercial |
$1,488.36
|
| Rate for Payer: HFN Commercial |
$1,538.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,254.24
|
| Rate for Payer: Multiplan Commercial |
$1,337.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,003.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,538.53
|
| Rate for Payer: Quartz Beloit One Network |
$819.44
|
| Rate for Payer: Quartz Commercial |
$1,087.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,003.39
|
| Rate for Payer: The Alliance Commercial |
$836.16
|
| Rate for Payer: WEA Trust Commercial |
$919.78
|
| Rate for Payer: WPS Commercial |
$1,238.64
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR HD 11/13FR X 28MM M0062502210
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6021629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.46 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Aetna Managed Medicare |
$441.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.31
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,182.48
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: NAPHCARE Commercial |
$945.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$1,024.82
|
| Rate for Payer: Quartz Medicare Advantage |
$945.98
|
| Rate for Payer: The Alliance Commercial |
$788.32
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR HD 11/13FR X 28MM M0062502210
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6021629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$772.55 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$945.98
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
