|
Cast Sup Short Leg Ped Fbrgl Q4040
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS Q4040
|
| Hospital Charge Code |
3133637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$109.12 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$109.12
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$71.77 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.74
|
| Rate for Payer: Anthem Medicare Advantage |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.74
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.74
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.74
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$37.11
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$24.74
|
| Rate for Payer: The Alliance Commercial |
$68.04
|
| Rate for Payer: United Healthcare Medicaid |
$14.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.74
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$43.30
|
|
|
Cast Sup Short Leg Splint Fbrgl Q4046
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS Q4046
|
| Hospital Charge Code |
3133622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$98.97 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.26
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$41.81
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$41.81
|
| Rate for Payer: The Alliance Commercial |
$98.97
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$35.94 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.38
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.38
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$18.56
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: Quartz Medicare Advantage |
$12.38
|
| Rate for Payer: The Alliance Commercial |
$34.03
|
| Rate for Payer: United Healthcare Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.38
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$21.66
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Cast Sup Short Leg Splint Ped Fbrgl Q4048
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS Q4048
|
| Hospital Charge Code |
3142823
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
CAST SYNTH 4X15
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$46.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.02
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$99.22
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$99.22
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CAST SYNTH 4X15
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS A4590
|
| Hospital Charge Code |
2963351
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
|
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,884.34 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,531.84
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
CATARACT EXTRACTION W/ INTRAOCULAR LENS IMPLANT
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.19 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.12
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,414.80
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,531.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,826.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,531.84
|
| Rate for Payer: The Alliance Commercial |
$2,943.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
CATARACT EXTRACTION W/ IO LENS IMPLANT & ISTENT INSERT +1
|
Facility
|
OP
|
$8,095.00
|
|
| Hospital Charge Code |
5383076
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,357.26 |
| Max. Negotiated Rate |
$7,745.30 |
| Rate for Payer: Aetna Commercial |
$7,576.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,240.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,357.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,472.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,209.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,041.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,461.96
|
| Rate for Payer: Cash Price |
$2,428.50
|
| Rate for Payer: Cigna Commercial |
$7,745.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,711.29
|
| Rate for Payer: Health EOS Commercial |
$7,492.73
|
| Rate for Payer: HFN Commercial |
$7,745.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,314.10
|
| Rate for Payer: Multiplan Commercial |
$6,735.04
|
| Rate for Payer: NAPHCARE Commercial |
$5,051.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,745.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,125.21
|
| Rate for Payer: Quartz Commercial |
$5,472.22
|
| Rate for Payer: Quartz Medicare Advantage |
$5,051.28
|
| Rate for Payer: The Alliance Commercial |
$4,209.40
|
| Rate for Payer: WEA Trust Commercial |
$4,630.34
|
| Rate for Payer: WPS Commercial |
$6,235.58
|
|
|
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 |
$4,125.21 |
| Max. Negotiated Rate |
$7,745.30 |
| Rate for Payer: Aetna Commercial |
$7,576.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,240.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,461.96
|
| Rate for Payer: Cash Price |
$2,428.50
|
| Rate for Payer: Cigna Commercial |
$7,745.30
|
| Rate for Payer: Health EOS Commercial |
$7,492.73
|
| Rate for Payer: HFN Commercial |
$7,745.30
|
| Rate for Payer: Multiplan Commercial |
$6,735.04
|
| Rate for Payer: Preferred Network Access Commercial |
$7,745.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,125.21
|
| Rate for Payer: Quartz Commercial |
$5,051.28
|
| Rate for Payer: WEA Trust Commercial |
$4,630.34
|
| Rate for Payer: WPS Commercial |
$6,235.58
|
|
|
CATARACT PROCEDURES
|
Facility
|
OP
|
$1,457.05
|
|
|
Service Code
|
EAPG 00233
|
| Min. Negotiated Rate |
$1,401.01 |
| Max. Negotiated Rate |
$1,457.05 |
| Rate for Payer: Anthem Medicaid |
$1,401.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,401.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,401.01
|
| Rate for Payer: Dean Health Medicaid |
$1,401.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,401.01
|
| Rate for Payer: Managed Health Services Medicaid |
$1,457.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,401.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,401.01
|
| Rate for Payer: United Healthcare Medicaid |
$1,401.01
|
|
|
CATARACTS
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00551
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
Catecholamines Fractionated
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,048.27 |
| Rate for Payer: Aetna Commercial |
$1,048.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,048.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$1,004.13
|
| Rate for Payer: HFN Commercial |
$1,048.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,048.27
|
| Rate for Payer: Quartz Beloit One Network |
$485.51
|
| Rate for Payer: Quartz Commercial |
$628.96
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$103.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: WPS Commercial |
$115.54
|
|
|
Catecholamines Fractionated
|
Facility
|
IP
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$540.69 |
| Max. Negotiated Rate |
$1,015.16 |
| Rate for Payer: Aetna Commercial |
$993.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.82
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,015.16
|
| Rate for Payer: Health EOS Commercial |
$982.06
|
| Rate for Payer: HFN Commercial |
$1,015.16
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.16
|
| Rate for Payer: Quartz Beloit One Network |
$540.69
|
| Rate for Payer: Quartz Commercial |
$662.06
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: WPS Commercial |
$817.29
|
|
|
Catecholamines Fractionated
|
Facility
|
OP
|
$1,061.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,015.16 |
| Rate for Payer: Aetna Commercial |
$993.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.59
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,015.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$982.06
|
| Rate for Payer: HFN Commercial |
$1,015.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.16
|
| Rate for Payer: Quartz Beloit One Network |
$540.69
|
| Rate for Payer: Quartz Commercial |
$717.24
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: United Healthcare PPO |
$827.58
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: Wellcare Medicare |
$26.26
|
| Rate for Payer: WPS Commercial |
$817.29
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.59
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$443.46
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: United Healthcare PPO |
$511.68
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: Wellcare Medicare |
$26.26
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$409.34
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Catecholamines Fractionated 24 Hour Urine
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
977898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$648.13 |
| Rate for Payer: Aetna Commercial |
$648.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$648.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$341.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$620.84
|
| Rate for Payer: HFN Commercial |
$648.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$648.13
|
| Rate for Payer: Quartz Beloit One Network |
$300.19
|
| Rate for Payer: Quartz Commercial |
$388.88
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$103.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$115.54
|
|
|
Catecholamines, Fractionated, Random Urine
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$105.04 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$26.26
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catecholamines, Fractionated, Random Urine
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catecholamines, Fractionated, Random Urine
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
3595614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$115.54 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$103.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$115.54
|
|
|
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 |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
