|
CATARACT EXTRACTION W/ IO LENS IMPLANT & ISTENT INSERT +1
|
Facility
IP
|
$8,095.00
|
|
| Hospital Charge Code |
5383076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,966.55 |
| Max. Negotiated Rate |
$7,447.40 |
| Rate for Payer: Aetna Commercial |
$7,285.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,290.35
|
| Rate for Payer: Cash Price |
$2,428.50
|
| Rate for Payer: Cigna Commercial |
$7,447.40
|
| Rate for Payer: Health EOS Commercial |
$7,204.55
|
| Rate for Payer: HFN Commercial |
$7,447.40
|
| Rate for Payer: Multiplan Commercial |
$6,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,857.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,447.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,966.55
|
| Rate for Payer: Quartz Commercial |
$4,857.00
|
| Rate for Payer: WEA Trust Commercial |
$4,452.25
|
| Rate for Payer: WPS Commercial |
$5,995.97
|
|
|
Catecholamines Fractionated
|
Facility
IP
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$519.89 |
| Max. Negotiated Rate |
$976.12 |
| Rate for Payer: Aetna Commercial |
$954.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.33
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$976.12
|
| Rate for Payer: Health EOS Commercial |
$944.29
|
| Rate for Payer: HFN Commercial |
$976.12
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: NAPHCARE Commercial |
$636.60
|
| Rate for Payer: Preferred Network Access Commercial |
$976.12
|
| Rate for Payer: Quartz Beloit One Network |
$519.89
|
| Rate for Payer: Quartz Commercial |
$636.60
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: WPS Commercial |
$785.88
|
|
|
Catecholamines Fractionated
|
Facility
OP
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$4,244.00 |
| Rate for Payer: Aetna Commercial |
$954.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.46
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.92
|
| Rate for Payer: Anthem Medicaid |
$26.09
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$976.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$944.29
|
| Rate for Payer: HFN Commercial |
$976.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Managed Health Services Medicaid |
$27.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: NAPHCARE Commercial |
$37.88
|
| Rate for Payer: Preferred Network Access Commercial |
$976.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.09
|
| Rate for Payer: Quartz Beloit One Network |
$519.89
|
| Rate for Payer: Quartz Commercial |
$689.65
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$4,244.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare PPO |
$795.75
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: Wellcare Medicare |
$25.25
|
| Rate for Payer: WMAP Medicaid |
$26.09
|
| Rate for Payer: WPS Commercial |
$785.88
|
|
|
Catecholamines Fractionated
|
Professional
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$1,007.95 |
| Rate for Payer: Aetna Commercial |
$1,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.46
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,007.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$965.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.95
|
| Rate for Payer: Quartz Beloit One Network |
$466.84
|
| Rate for Payer: Quartz Commercial |
$604.77
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$99.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Professional
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Aetna Commercial |
$623.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$623.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$596.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.20
|
| Rate for Payer: Quartz Beloit One Network |
$288.64
|
| Rate for Payer: Quartz Commercial |
$373.92
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$99.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Facility
OP
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.92
|
| Rate for Payer: Anthem Medicaid |
$26.09
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Managed Health Services Medicaid |
$27.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$37.88
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.09
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$426.40
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare PPO |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: Wellcare Medicare |
$25.25
|
| Rate for Payer: WMAP Medicaid |
$26.09
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Facility
IP
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$603.52 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$393.60
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
Catecholamines, Fractionated, Random Urine
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Catecholamines, Fractionated, Random Urine
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Anthem Medicaid |
$26.09
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicaid |
$26.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Managed Health Services Medicaid |
$27.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.88
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.09
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$208.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$25.25
|
| Rate for Payer: WMAP Medicaid |
$26.09
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Catecholamines, Fractionated, Random Urine
|
Professional
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$111.10 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$99.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
CATH 3-WAY IRRIG 20 FR 30CC 0167L20
|
Facility
IP
|
$248.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
CATH 3-WAY IRRIG 20 FR 30CC 0167L20
|
Facility
OP
|
$248.00
|
|
|
Service Code
|
HCPCS A4346
|
| Hospital Charge Code |
2963203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
CATH 9FR DUAL LUMEN HICKMAN 0600600
|
Facility
OP
|
$3,640.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2963094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.20 |
| Max. Negotiated Rate |
$3,348.80 |
| Rate for Payer: Aetna Commercial |
$3,276.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,130.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,019.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,366.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,820.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,747.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,929.20
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,348.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,036.94
|
| Rate for Payer: Health EOS Commercial |
$3,239.60
|
| Rate for Payer: HFN Commercial |
$3,348.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,348.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,783.60
|
| Rate for Payer: Quartz Commercial |
$2,366.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,184.00
|
| Rate for Payer: WEA Trust Commercial |
$2,002.00
|
| Rate for Payer: WPS Commercial |
$2,696.15
|
|
|
CATH 9FR DUAL LUMEN HICKMAN 0600600
|
Facility
IP
|
$3,640.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2963094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,783.60 |
| Max. Negotiated Rate |
$3,348.80 |
| Rate for Payer: Aetna Commercial |
$3,276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,929.20
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,348.80
|
| Rate for Payer: Health EOS Commercial |
$3,239.60
|
| Rate for Payer: HFN Commercial |
$3,348.80
|
| Rate for Payer: Multiplan Commercial |
$2,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,348.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,783.60
|
| Rate for Payer: Quartz Commercial |
$2,184.00
|
| Rate for Payer: WEA Trust Commercial |
$2,002.00
|
| Rate for Payer: WPS Commercial |
$2,696.15
|
|
|
CATH ANGIO 16GX1.16 AUTOGUARD BC 382554
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 16GX1.16 AUTOGUARD BC 382554
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 18GX1.16 AUTOGUARD BC 382544
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 18GX1.16 AUTOGUARD BC 382544
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 18GX1.25 NEXIVA DUAL PORT 383539
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
CATH ANGIO 18GX1.25 NEXIVA DUAL PORT 383539
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
CATH ANGIO 20GX1.16 AUTOGUARD BC 382534
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATH ANGIO 20GX1.16 AUTOGUARD BC 382534
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
CATH ANGIO 22GX1 AUTOGUARD BC 382523
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
4519577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 22GX1 AUTOGUARD BC 382523
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
4519577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
CATH ANGIO 22GX1 NEXIVA DUAL PORT 383532
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4519145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
