|
Endotrach Guide Stylet
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3040315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$124,519.99
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$44,211.36 |
| Max. Negotiated Rate |
$124,519.99 |
| Rate for Payer: Aetna Managed Medicare |
$44,211.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124,519.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95,443.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90,677.62
|
| Rate for Payer: Anthem Medicare Advantage |
$44,211.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,211.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,211.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,211.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100,660.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,211.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,211.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,211.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,211.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,211.36
|
| Rate for Payer: NAPHCARE Commercial |
$66,317.04
|
| Rate for Payer: Quartz Medicare Advantage |
$44,211.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,211.36
|
| Rate for Payer: Wellcare Medicare |
$44,211.36
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$173,034.16
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$47,439.27 |
| Max. Negotiated Rate |
$173,034.16 |
| Rate for Payer: Aetna Managed Medicare |
$47,439.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133,716.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102,492.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97,374.88
|
| Rate for Payer: Anthem Medicare Advantage |
$47,439.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47,439.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47,439.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47,439.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108,095.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47,439.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126,670.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47,439.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47,439.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47,439.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47,439.27
|
| Rate for Payer: NAPHCARE Commercial |
$71,158.90
|
| Rate for Payer: Quartz Medicare Advantage |
$47,439.27
|
| Rate for Payer: The Alliance Commercial |
$173,034.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,439.27
|
| Rate for Payer: United Healthcare PPO |
$98,614.92
|
| Rate for Payer: Wellcare Medicare |
$47,439.27
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$135,267.60
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$36,965.93 |
| Max. Negotiated Rate |
$135,267.60 |
| Rate for Payer: Aetna Managed Medicare |
$36,965.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103,876.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79,620.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75,644.92
|
| Rate for Payer: Anthem Medicare Advantage |
$36,965.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,965.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,965.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,965.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83,972.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,965.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98,970.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,965.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,965.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,965.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,965.93
|
| Rate for Payer: NAPHCARE Commercial |
$55,448.89
|
| Rate for Payer: Quartz Medicare Advantage |
$36,965.93
|
| Rate for Payer: The Alliance Commercial |
$135,267.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,965.93
|
| Rate for Payer: United Healthcare PPO |
$77,049.77
|
| Rate for Payer: Wellcare Medicare |
$36,965.93
|
|
|
ENDOVENOUS ABLATION 1ST VEIN
|
Facility
|
IP
|
$10,810.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
6179652
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,508.78 |
| Max. Negotiated Rate |
$10,343.01 |
| Rate for Payer: Aetna Commercial |
$10,118.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,668.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,958.47
|
| Rate for Payer: Cash Price |
$3,243.00
|
| Rate for Payer: Cigna Commercial |
$10,343.01
|
| Rate for Payer: Health EOS Commercial |
$10,005.74
|
| Rate for Payer: HFN Commercial |
$10,343.01
|
| Rate for Payer: Multiplan Commercial |
$8,993.92
|
| Rate for Payer: Preferred Network Access Commercial |
$10,343.01
|
| Rate for Payer: Quartz Beloit One Network |
$5,508.78
|
| Rate for Payer: Quartz Commercial |
$6,745.44
|
| Rate for Payer: WEA Trust Commercial |
$6,183.32
|
| Rate for Payer: WPS Commercial |
$8,326.94
|
|
|
ENDOVENOUS ABLATION 1ST VEIN
|
Facility
|
OP
|
$10,810.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
6179652
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$10,118.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,668.46
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,958.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$3,243.00
|
| Rate for Payer: Cash Price |
$3,243.00
|
| Rate for Payer: Cash Price |
$3,243.00
|
| Rate for Payer: Cigna Commercial |
$10,343.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$10,005.74
|
| Rate for Payer: HFN Commercial |
$10,343.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,993.92
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,343.01
|
| Rate for Payer: Quartz Beloit One Network |
$5,508.78
|
| Rate for Payer: Quartz Commercial |
$7,307.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$6,183.32
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$8,326.94
|
|
|
ENDOVENOUS ABLATION 2ND VEIN
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
6179651
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,668.78 |
| Max. Negotiated Rate |
$5,010.76 |
| Rate for Payer: Aetna Commercial |
$4,901.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,683.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,886.63
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cigna Commercial |
$5,010.76
|
| Rate for Payer: Health EOS Commercial |
$4,847.37
|
| Rate for Payer: HFN Commercial |
$5,010.76
|
| Rate for Payer: Multiplan Commercial |
$4,357.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,010.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,668.78
|
| Rate for Payer: Quartz Commercial |
$3,267.89
|
| Rate for Payer: WEA Trust Commercial |
$2,995.56
|
| Rate for Payer: WPS Commercial |
$4,034.06
|
|
|
ENDOVENOUS ABLATION 2ND VEIN
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
6179651
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$5,010.76 |
| Rate for Payer: Aetna Commercial |
$4,901.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,683.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,525.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,540.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,723.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,614.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,886.63
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cigna Commercial |
$5,010.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$4,847.37
|
| Rate for Payer: HFN Commercial |
$5,010.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,084.86
|
| Rate for Payer: Multiplan Commercial |
$4,357.18
|
| Rate for Payer: NAPHCARE Commercial |
$3,267.89
|
| Rate for Payer: Preferred Network Access Commercial |
$5,010.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,668.78
|
| Rate for Payer: Quartz Commercial |
$3,540.21
|
| Rate for Payer: Quartz Medicare Advantage |
$3,267.89
|
| Rate for Payer: The Alliance Commercial |
$432.14
|
| Rate for Payer: WEA Trust Commercial |
$2,995.56
|
| Rate for Payer: WPS Commercial |
$4,034.06
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
ENDOVENOUS LASER, 1ST VEIN 36478
|
Professional
|
Both
|
$7,570.00
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
3014527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.85 |
| Max. Negotiated Rate |
$7,479.16 |
| Rate for Payer: Aetna Commercial |
$7,479.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,770.61
|
| Rate for Payer: Aetna Managed Medicare |
$228.85
|
| Rate for Payer: Anthem Medicare Advantage |
$228.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$228.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$228.85
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$7,479.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,354.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.85
|
| Rate for Payer: Health EOS Commercial |
$7,164.25
|
| Rate for Payer: HFN Commercial |
$7,479.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$929.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$929.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$228.85
|
| Rate for Payer: Multiplan Commercial |
$6,298.24
|
| Rate for Payer: NAPHCARE Commercial |
$343.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,479.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,464.03
|
| Rate for Payer: Quartz Commercial |
$4,487.50
|
| Rate for Payer: Quartz Medicare Advantage |
$228.85
|
| Rate for Payer: The Alliance Commercial |
$972.62
|
| Rate for Payer: United Healthcare Medicaid |
$1,354.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$228.85
|
| Rate for Payer: WEA Trust Commercial |
$4,330.04
|
| Rate for Payer: WPS Commercial |
$1,029.83
|
|
|
Endovenous Laser, Vein Add On 36479
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
3014528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.38 |
| Max. Negotiated Rate |
$2,212.13 |
| Rate for Payer: Aetna Commercial |
$2,212.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.38
|
| Rate for Payer: Anthem Medicare Advantage |
$110.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.38
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,212.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.38
|
| Rate for Payer: Health EOS Commercial |
$2,118.99
|
| Rate for Payer: HFN Commercial |
$2,212.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.38
|
| Rate for Payer: Multiplan Commercial |
$1,862.85
|
| Rate for Payer: NAPHCARE Commercial |
$165.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,212.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,024.57
|
| Rate for Payer: Quartz Commercial |
$1,327.28
|
| Rate for Payer: Quartz Medicare Advantage |
$110.38
|
| Rate for Payer: The Alliance Commercial |
$469.09
|
| Rate for Payer: United Healthcare Medicaid |
$247.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.38
|
| Rate for Payer: WEA Trust Commercial |
$1,280.71
|
| Rate for Payer: WPS Commercial |
$496.69
|
|
|
ENDOVENOUS RF, 1ST VEIN 36475
|
Professional
|
Both
|
$3,400.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
3014525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$227.17 |
| Max. Negotiated Rate |
$3,359.20 |
| Rate for Payer: Aetna Commercial |
$3,359.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,040.96
|
| Rate for Payer: Aetna Managed Medicare |
$227.17
|
| Rate for Payer: Anthem Medicare Advantage |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.17
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,359.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,639.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.17
|
| Rate for Payer: Health EOS Commercial |
$3,217.76
|
| Rate for Payer: HFN Commercial |
$3,359.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$929.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$929.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$2,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$340.75
|
| Rate for Payer: Preferred Network Access Commercial |
$3,359.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.84
|
| Rate for Payer: Quartz Commercial |
$2,015.52
|
| Rate for Payer: Quartz Medicare Advantage |
$227.17
|
| Rate for Payer: The Alliance Commercial |
$965.46
|
| Rate for Payer: United Healthcare Medicaid |
$1,639.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.17
|
| Rate for Payer: WEA Trust Commercial |
$1,944.80
|
| Rate for Payer: WPS Commercial |
$1,022.25
|
|
|
Endovenous RF, 1st Vein 3647550
|
Professional
|
Both
|
$6,800.00
|
|
|
Service Code
|
CPT 36475 50
|
| Hospital Charge Code |
4822607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$929.40 |
| Max. Negotiated Rate |
$6,718.40 |
| Rate for Payer: Aetna Commercial |
$6,718.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,081.92
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cigna Commercial |
$6,718.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,639.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,243.20
|
| Rate for Payer: Health EOS Commercial |
$6,435.52
|
| Rate for Payer: HFN Commercial |
$6,718.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$929.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$929.40
|
| Rate for Payer: Multiplan Commercial |
$5,657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,718.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,111.68
|
| Rate for Payer: Quartz Commercial |
$4,031.04
|
| Rate for Payer: The Alliance Commercial |
$3,536.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,639.92
|
| Rate for Payer: WEA Trust Commercial |
$3,889.60
|
| Rate for Payer: WPS Commercial |
$5,238.04
|
|
|
Endovenous RF, Vein Add On 36476
|
Professional
|
Both
|
$3,888.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
3014526
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$3,841.34 |
| Rate for Payer: Aetna Commercial |
$3,841.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,477.43
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| Rate for Payer: Anthem Medicare Advantage |
$108.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.04
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,841.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.04
|
| Rate for Payer: Health EOS Commercial |
$3,679.60
|
| Rate for Payer: HFN Commercial |
$3,841.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$446.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.04
|
| Rate for Payer: Multiplan Commercial |
$3,234.82
|
| Rate for Payer: NAPHCARE Commercial |
$162.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,841.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,779.15
|
| Rate for Payer: Quartz Commercial |
$2,304.81
|
| Rate for Payer: Quartz Medicare Advantage |
$108.04
|
| Rate for Payer: The Alliance Commercial |
$459.15
|
| Rate for Payer: United Healthcare Medicaid |
$234.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.04
|
| Rate for Payer: WEA Trust Commercial |
$2,223.94
|
| Rate for Payer: WPS Commercial |
$486.16
|
|
|
ENEMA OIL
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2963309
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
ENEMA OIL
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2963309
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
ENEMA PHOSPHATE LATEX FREE FLT201
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2963470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$35.57
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
ENEMA PHOSPHATE LATEX FREE FLT201
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2963470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Enoxaparin JW Waste Charge per 10 mg
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS J1650 JW
|
| Hospital Charge Code |
5266685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
Enoxaparin JW Waste Charge per 10 mg
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J1650 JW
|
| Hospital Charge Code |
5266685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.64
|
| Rate for Payer: Health EOS Commercial |
$18.93
|
| Rate for Payer: HFN Commercial |
$19.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Preferred Network Access Commercial |
$19.76
|
| Rate for Payer: Quartz Beloit One Network |
$9.15
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: The Alliance Commercial |
$10.40
|
| Rate for Payer: United Healthcare Medicaid |
$0.55
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$1.61
|
|
|
Enoxaparin JW Waste Charge per 10 mg
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J1650 JW
|
| Hospital Charge Code |
5266685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.85
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$12.48
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$13.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12.48
|
| Rate for Payer: The Alliance Commercial |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$1.61
|
|
|
EnSnare Kit 18-30mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
EnSnare Kit 18-30mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
EnSnare Kit 18-30mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
EnSnare Kit 6-10mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
