|
EP Induction Of Arrhythmia
|
Facility
|
IP
|
$18,016.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
3052506
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,180.95 |
| Max. Negotiated Rate |
$17,237.71 |
| Rate for Payer: Aetna Commercial |
$16,862.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,113.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,930.42
|
| Rate for Payer: Cash Price |
$5,404.80
|
| Rate for Payer: Cigna Commercial |
$17,237.71
|
| Rate for Payer: Health EOS Commercial |
$16,675.61
|
| Rate for Payer: HFN Commercial |
$17,237.71
|
| Rate for Payer: Multiplan Commercial |
$14,989.31
|
| Rate for Payer: Preferred Network Access Commercial |
$17,237.71
|
| Rate for Payer: Quartz Beloit One Network |
$9,180.95
|
| Rate for Payer: Quartz Commercial |
$11,241.98
|
| Rate for Payer: WEA Trust Commercial |
$10,305.15
|
| Rate for Payer: WPS Commercial |
$13,877.72
|
|
|
Epinephrine 1:1000 1mg/1ml ampule [Med]
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Epinephrine 1:1000 1mg/1ml ampule [Med]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$14.35
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.35
|
| Rate for Payer: The Alliance Commercial |
$11.96
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
Epinephrine 1:1000 30ml vial [Med]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$6.86
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$8.47
|
|
|
Epinephrine 1:1000 30ml vial [Med]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Aetna Managed Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: NAPHCARE Commercial |
$6.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$7.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6.86
|
| Rate for Payer: The Alliance Commercial |
$5.72
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$2.11
|
|
|
EP Intra-Artial/Vent Mapping Tachy +
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
3052505
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$441.31 |
| Max. Negotiated Rate |
$828.59 |
| Rate for Payer: Aetna Commercial |
$810.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.34
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$828.59
|
| Rate for Payer: Health EOS Commercial |
$801.57
|
| Rate for Payer: HFN Commercial |
$828.59
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: Preferred Network Access Commercial |
$828.59
|
| Rate for Payer: Quartz Beloit One Network |
$441.31
|
| Rate for Payer: Quartz Commercial |
$540.38
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: WPS Commercial |
$667.08
|
|
|
EP Intra-Artial/Vent Mapping Tachy +
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 93609
|
| Hospital Charge Code |
3052505
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$252.18 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$810.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Aetna Managed Medicare |
$252.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.34
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$828.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.01
|
| Rate for Payer: Health EOS Commercial |
$801.57
|
| Rate for Payer: HFN Commercial |
$828.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.48
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: NAPHCARE Commercial |
$540.38
|
| Rate for Payer: Preferred Network Access Commercial |
$828.59
|
| Rate for Payer: Quartz Beloit One Network |
$441.31
|
| Rate for Payer: Quartz Commercial |
$585.42
|
| Rate for Payer: Quartz Medicare Advantage |
$540.38
|
| Rate for Payer: The Alliance Commercial |
$450.32
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: WPS Commercial |
$667.08
|
|
|
EP Intra-Atrial Pacing
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
4125699
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$641.08 |
| Max. Negotiated Rate |
$1,203.65 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$784.99
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
EP Intra-Atrial Pacing
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 93610
|
| Hospital Charge Code |
4125699
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$641.08 |
| Max. Negotiated Rate |
$32,833.13 |
| Rate for Payer: Aetna Commercial |
$1,177.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.16
|
| Rate for Payer: Aetna Managed Medicare |
$8,208.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,208.28
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cash Price |
$377.40
|
| Rate for Payer: Cigna Commercial |
$1,203.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,208.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,208.28
|
| Rate for Payer: Health EOS Commercial |
$1,164.40
|
| Rate for Payer: HFN Commercial |
$1,203.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,534.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,208.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,208.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,208.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,208.28
|
| Rate for Payer: Multiplan Commercial |
$1,046.66
|
| Rate for Payer: NAPHCARE Commercial |
$12,312.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.65
|
| Rate for Payer: Quartz Beloit One Network |
$641.08
|
| Rate for Payer: Quartz Commercial |
$850.41
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.28
|
| Rate for Payer: The Alliance Commercial |
$32,833.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,208.28
|
| Rate for Payer: WEA Trust Commercial |
$719.58
|
| Rate for Payer: Wellcare Medicare |
$8,208.28
|
| Rate for Payer: WPS Commercial |
$969.04
|
|
|
EP Intra-Atrial Recording
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
4125701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$448.96 |
| Max. Negotiated Rate |
$32,833.13 |
| Rate for Payer: Aetna Commercial |
$824.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.97
|
| Rate for Payer: Aetna Managed Medicare |
$8,208.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,208.28
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$842.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,208.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,208.28
|
| Rate for Payer: Health EOS Commercial |
$815.45
|
| Rate for Payer: HFN Commercial |
$842.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,534.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,208.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,208.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,208.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,208.28
|
| Rate for Payer: Multiplan Commercial |
$732.99
|
| Rate for Payer: NAPHCARE Commercial |
$12,312.42
|
| Rate for Payer: Preferred Network Access Commercial |
$842.94
|
| Rate for Payer: Quartz Beloit One Network |
$448.96
|
| Rate for Payer: Quartz Commercial |
$595.56
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.28
|
| Rate for Payer: The Alliance Commercial |
$32,833.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,208.28
|
| Rate for Payer: WEA Trust Commercial |
$503.93
|
| Rate for Payer: Wellcare Medicare |
$8,208.28
|
| Rate for Payer: WPS Commercial |
$678.63
|
|
|
EP Intra-Atrial Recording
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 93602
|
| Hospital Charge Code |
4125701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$448.96 |
| Max. Negotiated Rate |
$842.94 |
| Rate for Payer: Aetna Commercial |
$824.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.61
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$842.94
|
| Rate for Payer: Health EOS Commercial |
$815.45
|
| Rate for Payer: HFN Commercial |
$842.94
|
| Rate for Payer: Multiplan Commercial |
$732.99
|
| Rate for Payer: Preferred Network Access Commercial |
$842.94
|
| Rate for Payer: Quartz Beloit One Network |
$448.96
|
| Rate for Payer: Quartz Commercial |
$549.74
|
| Rate for Payer: WEA Trust Commercial |
$503.93
|
| Rate for Payer: WPS Commercial |
$678.63
|
|
|
EP Intra Ventricular Pacing
|
Facility
|
OP
|
$1,117.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
4125698
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$569.22 |
| Max. Negotiated Rate |
$32,833.13 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$8,208.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,208.28
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,208.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,208.28
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,534.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,208.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,208.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,208.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,208.28
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$12,312.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$755.09
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.28
|
| Rate for Payer: The Alliance Commercial |
$32,833.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,208.28
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: Wellcare Medicare |
$8,208.28
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
EP Intra Ventricular Pacing
|
Facility
|
IP
|
$1,117.00
|
|
|
Service Code
|
CPT 93612
|
| Hospital Charge Code |
4125698
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$569.22 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$697.01
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
EPISIOTOMY OR VAGINAL REPAIR 59300
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 59300
|
| Hospital Charge Code |
3015153
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$734.08 |
| Rate for Payer: Aetna Commercial |
$734.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Aetna Managed Medicare |
$119.38
|
| Rate for Payer: Anthem Medicare Advantage |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.38
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$734.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.38
|
| Rate for Payer: Health EOS Commercial |
$703.18
|
| Rate for Payer: HFN Commercial |
$734.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.38
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: NAPHCARE Commercial |
$179.07
|
| Rate for Payer: Preferred Network Access Commercial |
$734.08
|
| Rate for Payer: Quartz Beloit One Network |
$340.00
|
| Rate for Payer: Quartz Commercial |
$440.45
|
| Rate for Payer: Quartz Medicare Advantage |
$119.38
|
| Rate for Payer: The Alliance Commercial |
$507.37
|
| Rate for Payer: United Healthcare Medicaid |
$173.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.38
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$537.22
|
|
|
EPISTAXIS CONTROL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
EPISTAXIS CONTROL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$36,678.72
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,703.67 |
| Max. Negotiated Rate |
$36,678.72 |
| Rate for Payer: Aetna Managed Medicare |
$10,703.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,052.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,268.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,156.36
|
| Rate for Payer: Anthem Medicare Advantage |
$10,703.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,703.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,703.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,703.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,485.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,703.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,658.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,703.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,703.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,703.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,703.67
|
| Rate for Payer: NAPHCARE Commercial |
$16,055.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,703.67
|
| Rate for Payer: The Alliance Commercial |
$36,678.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,703.67
|
| Rate for Payer: United Healthcare PPO |
$20,753.64
|
| Rate for Payer: Wellcare Medicare |
$10,703.67
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$21,642.40
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$6,127.90 |
| Max. Negotiated Rate |
$21,642.40 |
| Rate for Payer: Aetna Managed Medicare |
$6,127.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,015.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,275.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,662.61
|
| Rate for Payer: Anthem Medicare Advantage |
$6,127.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,127.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,127.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,127.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,946.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,127.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,629.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,127.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,127.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,127.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,127.90
|
| Rate for Payer: NAPHCARE Commercial |
$9,191.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,127.90
|
| Rate for Payer: The Alliance Commercial |
$21,642.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,127.90
|
| Rate for Payer: United Healthcare PPO |
$12,168.00
|
| Rate for Payer: Wellcare Medicare |
$6,127.90
|
|
|
EP LV Pacing & Recording +
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
3052509
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$586.55 |
| Max. Negotiated Rate |
$1,101.28 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$718.22
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
EP LV Pacing & Recording +
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT 93622
|
| Hospital Charge Code |
3052509
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$335.17 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$1,077.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,029.45
|
| Rate for Payer: Aetna Managed Medicare |
$335.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.43
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cash Price |
$345.30
|
| Rate for Payer: Cigna Commercial |
$1,101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$669.88
|
| Rate for Payer: Health EOS Commercial |
$1,065.37
|
| Rate for Payer: HFN Commercial |
$1,101.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.78
|
| Rate for Payer: Multiplan Commercial |
$957.63
|
| Rate for Payer: NAPHCARE Commercial |
$718.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.28
|
| Rate for Payer: Quartz Beloit One Network |
$586.55
|
| Rate for Payer: Quartz Commercial |
$778.08
|
| Rate for Payer: Quartz Medicare Advantage |
$718.22
|
| Rate for Payer: The Alliance Commercial |
$598.52
|
| Rate for Payer: WEA Trust Commercial |
$658.37
|
| Rate for Payer: WPS Commercial |
$886.62
|
|
|
EPO / 100 Units Below
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
3603551
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.14
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$3.20
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$2.15
|
|
|
EPO / 100 Units Below
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
3603551
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
EPO / 100 Units Below PD
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
3603569
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
EPO / 100 Units Below PD
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS Q4081
|
| Hospital Charge Code |
3603569
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.14
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$3.20
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$2.15
|
|
|
EPO / 100 units (Dialysis)
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS Q4055
|
| Hospital Charge Code |
3005570
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
