|
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
|
$372.66
|
|
|
Service Code
|
EAPG 00233
|
| Min. Negotiated Rate |
$358.33 |
| Max. Negotiated Rate |
$372.66 |
| Rate for Payer: Anthem Medicaid |
$358.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$358.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$358.33
|
| Rate for Payer: Dean Health Medicaid |
$358.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$358.33
|
| Rate for Payer: Managed Health Services Medicaid |
$372.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$358.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$358.33
|
| Rate for Payer: United Healthcare Medicaid |
$358.33
|
|
|
CATARACTS
|
Facility
|
OP
|
$23.57
|
|
|
Service Code
|
EAPG 00551
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Anthem Medicaid |
$22.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.66
|
| Rate for Payer: Dean Health Medicaid |
$22.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicaid |
$23.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.66
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.66
|
| Rate for Payer: United Healthcare Medicaid |
$22.66
|
|
|
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
|
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 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: Dean Health DHI/DHP/ASO |
$26.26
|
| 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: 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
|
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
|
|
|
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
|
|
|
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
|
|
|
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 |
$72.22 |
| Max. Negotiated Rate |
$237.29 |
| 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 |
$167.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.80
|
| 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 |
$115.27
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
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 |
$1,854.94 |
| Max. Negotiated Rate |
$3,482.75 |
| Rate for Payer: Aetna Commercial |
$3,407.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,255.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,006.37
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,482.75
|
| Rate for Payer: Health EOS Commercial |
$3,369.18
|
| Rate for Payer: HFN Commercial |
$3,482.75
|
| Rate for Payer: Multiplan Commercial |
$3,028.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,482.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.94
|
| Rate for Payer: Quartz Commercial |
$2,271.36
|
| Rate for Payer: WEA Trust Commercial |
$2,082.08
|
| Rate for Payer: WPS Commercial |
$2,803.89
|
|
|
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 |
$1,059.97 |
| Max. Negotiated Rate |
$3,482.75 |
| Rate for Payer: Aetna Commercial |
$3,407.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,255.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,460.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,892.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,817.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,006.37
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,482.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,118.48
|
| Rate for Payer: Health EOS Commercial |
$3,369.18
|
| Rate for Payer: HFN Commercial |
$3,482.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,839.20
|
| Rate for Payer: Multiplan Commercial |
$3,028.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,271.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,482.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.94
|
| Rate for Payer: Quartz Commercial |
$2,460.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,271.36
|
| Rate for Payer: The Alliance Commercial |
$1,892.80
|
| Rate for Payer: WEA Trust Commercial |
$2,082.08
|
| Rate for Payer: WPS Commercial |
$2,803.89
|
|
|
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 |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
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 |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
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 |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
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 |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
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 |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
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 |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
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 |
$22.71 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$48.67
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$48.67
|
| Rate for Payer: The Alliance Commercial |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
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 |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
