|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$130,065.00
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$46,786.05 |
| Max. Negotiated Rate |
$130,065.00 |
| Rate for Payer: Aetna Managed Medicare |
$46,786.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102,382.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78,475.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74,556.64
|
| Rate for Payer: Anthem Medicare Advantage |
$46,786.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,786.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,786.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,786.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82,764.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,786.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95,163.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,786.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,786.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,786.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,786.05
|
| Rate for Payer: NAPHCARE Commercial |
$70,179.08
|
| Rate for Payer: Quartz Medicare Advantage |
$46,786.05
|
| Rate for Payer: The Alliance Commercial |
$130,065.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,786.05
|
| Rate for Payer: United Healthcare PPO |
$74,086.32
|
| Rate for Payer: Wellcare Medicare |
$46,786.05
|
|
|
ENDOVENOUS ABLATION 1ST VEIN
|
Facility
|
OP
|
$10,810.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
6179652
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$9,729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,296.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,729.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| 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 |
$9,945.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,620.90
|
| Rate for Payer: HFN Commercial |
$9,945.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,945.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,296.90
|
| Rate for Payer: Quartz Commercial |
$7,026.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$5,945.50
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,006.97
|
|
|
ENDOVENOUS ABLATION 1ST VEIN
|
Facility
|
IP
|
$10,810.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
6179652
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,296.90 |
| Max. Negotiated Rate |
$9,945.20 |
| Rate for Payer: Aetna Commercial |
$9,729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,296.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,729.30
|
| Rate for Payer: Cash Price |
$3,243.00
|
| Rate for Payer: Cigna Commercial |
$9,945.20
|
| Rate for Payer: Health EOS Commercial |
$9,620.90
|
| Rate for Payer: HFN Commercial |
$9,945.20
|
| Rate for Payer: Multiplan Commercial |
$8,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,486.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,945.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,296.90
|
| Rate for Payer: Quartz Commercial |
$6,486.00
|
| Rate for Payer: WEA Trust Commercial |
$5,945.50
|
| Rate for Payer: WPS Commercial |
$8,006.97
|
|
|
ENDOVENOUS ABLATION 2ND VEIN
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
6179651
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,566.13 |
| Max. Negotiated Rate |
$4,818.04 |
| Rate for Payer: Aetna Commercial |
$4,713.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,503.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,775.61
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cigna Commercial |
$4,818.04
|
| Rate for Payer: Health EOS Commercial |
$4,660.93
|
| Rate for Payer: HFN Commercial |
$4,818.04
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,818.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,566.13
|
| Rate for Payer: Quartz Commercial |
$3,142.20
|
| Rate for Payer: WEA Trust Commercial |
$2,880.35
|
| Rate for Payer: WPS Commercial |
$3,879.05
|
|
|
ENDOVENOUS ABLATION 2ND VEIN
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
6179651
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,466.36 |
| Max. Negotiated Rate |
$20,948.00 |
| Rate for Payer: Aetna Commercial |
$4,713.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,503.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,466.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,404.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,618.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,513.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,775.61
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cash Price |
$1,571.10
|
| Rate for Payer: Cigna Commercial |
$4,818.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$4,660.93
|
| Rate for Payer: HFN Commercial |
$4,818.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,927.75
|
| Rate for Payer: Multiplan Commercial |
$4,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,818.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,566.13
|
| Rate for Payer: Quartz Commercial |
$3,404.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,142.20
|
| Rate for Payer: The Alliance Commercial |
$20,948.00
|
| Rate for Payer: WEA Trust Commercial |
$2,880.35
|
| Rate for Payer: WPS Commercial |
$3,879.05
|
|
|
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 36475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
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 |
$894.22 |
| Max. Negotiated Rate |
$7,191.50 |
| Rate for Payer: Aetna Commercial |
$7,191.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,510.20
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$7,191.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,302.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,542.00
|
| Rate for Payer: Health EOS Commercial |
$6,888.70
|
| Rate for Payer: HFN Commercial |
$7,191.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$894.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$894.22
|
| Rate for Payer: Multiplan Commercial |
$6,056.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,191.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,330.80
|
| Rate for Payer: Quartz Commercial |
$4,314.90
|
| Rate for Payer: The Alliance Commercial |
$3,785.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,302.14
|
| Rate for Payer: WEA Trust Commercial |
$4,163.50
|
| Rate for Payer: WPS Commercial |
$5,607.10
|
|
|
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 |
$237.71 |
| Max. Negotiated Rate |
$2,127.05 |
| Rate for Payer: Aetna Commercial |
$2,127.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,925.54
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cash Price |
$671.70
|
| Rate for Payer: Cigna Commercial |
$2,127.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.40
|
| Rate for Payer: Health EOS Commercial |
$2,037.49
|
| Rate for Payer: HFN Commercial |
$2,127.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$435.88
|
| Rate for Payer: Multiplan Commercial |
$1,791.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,127.05
|
| Rate for Payer: Quartz Beloit One Network |
$985.16
|
| Rate for Payer: Quartz Commercial |
$1,276.23
|
| Rate for Payer: The Alliance Commercial |
$1,119.50
|
| Rate for Payer: United Healthcare Medicaid |
$237.71
|
| Rate for Payer: WEA Trust Commercial |
$1,231.45
|
| Rate for Payer: WPS Commercial |
$1,658.43
|
|
|
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 |
$893.65 |
| Max. Negotiated Rate |
$3,230.00 |
| Rate for Payer: Aetna Commercial |
$3,230.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,924.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,230.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,576.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,040.00
|
| Rate for Payer: Health EOS Commercial |
$3,094.00
|
| Rate for Payer: HFN Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$893.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$893.65
|
| Rate for Payer: Multiplan Commercial |
$2,720.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,230.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.00
|
| Rate for Payer: Quartz Commercial |
$1,938.00
|
| Rate for Payer: The Alliance Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,576.85
|
| Rate for Payer: WEA Trust Commercial |
$1,870.00
|
| Rate for Payer: WPS Commercial |
$2,518.38
|
|
|
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 |
$1,576.85 |
| Max. Negotiated Rate |
$6,460.00 |
| Rate for Payer: Aetna Commercial |
$6,460.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,848.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cigna Commercial |
$6,460.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,576.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,080.00
|
| Rate for Payer: Health EOS Commercial |
$6,188.00
|
| Rate for Payer: HFN Commercial |
$6,460.00
|
| Rate for Payer: Multiplan Commercial |
$5,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,460.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,992.00
|
| Rate for Payer: Quartz Commercial |
$3,876.00
|
| Rate for Payer: The Alliance Commercial |
$3,400.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,576.85
|
| Rate for Payer: WEA Trust Commercial |
$3,740.00
|
| Rate for Payer: WPS Commercial |
$5,036.76
|
|
|
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 |
$225.61 |
| Max. Negotiated Rate |
$3,693.60 |
| Rate for Payer: Aetna Commercial |
$3,693.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,343.68
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cigna Commercial |
$3,693.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,332.80
|
| Rate for Payer: Health EOS Commercial |
$3,538.08
|
| Rate for Payer: HFN Commercial |
$3,693.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.64
|
| Rate for Payer: Multiplan Commercial |
$3,110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,693.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.72
|
| Rate for Payer: Quartz Commercial |
$2,216.16
|
| Rate for Payer: The Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare Medicaid |
$225.61
|
| Rate for Payer: WEA Trust Commercial |
$2,138.40
|
| Rate for Payer: WPS Commercial |
$2,879.84
|
|
|
ENEMA OIL
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2963309
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
ENEMA OIL
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2963309
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
ENEMA PHOSPHATE LATEX FREE FLT201
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2963470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$15.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
ENEMA PHOSPHATE LATEX FREE FLT201
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2963470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
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 |
$5.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.19
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
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 |
$8.80 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$18.20
|
| Rate for Payer: HFN Commercial |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$8.80
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$10.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
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 |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
EnSnare Kit 18-30mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 18-30mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 18-30mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 6-10mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 6-10mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 6-10mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
EnSnare Kit 9-15mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
