|
INFUSION CATHETER 5FR 10CM
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
INFUSION CATHETER 5FR 20CM
|
Facility
|
OP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2972386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.78 |
| Max. Negotiated Rate |
$1,904.99 |
| Rate for Payer: Aetna Commercial |
$1,863.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.75
|
| Rate for Payer: Aetna Managed Medicare |
$579.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,345.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,035.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$993.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.44
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,904.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,158.76
|
| Rate for Payer: Health EOS Commercial |
$1,842.87
|
| Rate for Payer: HFN Commercial |
$1,904.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,552.98
|
| Rate for Payer: Multiplan Commercial |
$1,656.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,242.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.61
|
| Rate for Payer: Quartz Commercial |
$1,345.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,242.38
|
| Rate for Payer: The Alliance Commercial |
$1,035.32
|
| Rate for Payer: WEA Trust Commercial |
$1,138.85
|
| Rate for Payer: WPS Commercial |
$1,533.67
|
|
|
INFUSION CATHETER 5FR 20CM
|
Facility
|
IP
|
$1,991.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2972386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.61 |
| Max. Negotiated Rate |
$1,904.99 |
| Rate for Payer: Aetna Commercial |
$1,863.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.44
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,904.99
|
| Rate for Payer: Health EOS Commercial |
$1,842.87
|
| Rate for Payer: HFN Commercial |
$1,904.99
|
| Rate for Payer: Multiplan Commercial |
$1,656.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.61
|
| Rate for Payer: Quartz Commercial |
$1,242.38
|
| Rate for Payer: WEA Trust Commercial |
$1,138.85
|
| Rate for Payer: WPS Commercial |
$1,533.67
|
|
|
INFUSION CATHETER 5FR 5CM
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
INFUSION CATHETER 5FR 5CM
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Catheter 65CM/135CM
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139304
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$889.25 |
| Max. Negotiated Rate |
$1,669.62 |
| Rate for Payer: Aetna Commercial |
$1,633.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,560.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$961.84
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,669.62
|
| Rate for Payer: Health EOS Commercial |
$1,615.17
|
| Rate for Payer: HFN Commercial |
$1,669.62
|
| Rate for Payer: Multiplan Commercial |
$1,451.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,669.62
|
| Rate for Payer: Quartz Beloit One Network |
$889.25
|
| Rate for Payer: Quartz Commercial |
$1,088.88
|
| Rate for Payer: WEA Trust Commercial |
$998.14
|
| Rate for Payer: WPS Commercial |
$1,344.17
|
|
|
Infusion Catheter 65CM/135CM
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139304
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$508.14 |
| Max. Negotiated Rate |
$1,669.62 |
| Rate for Payer: Aetna Commercial |
$1,633.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,560.73
|
| Rate for Payer: Aetna Managed Medicare |
$508.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,179.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$907.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$871.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$961.84
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,669.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.59
|
| Rate for Payer: Health EOS Commercial |
$1,615.17
|
| Rate for Payer: HFN Commercial |
$1,669.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,361.10
|
| Rate for Payer: Multiplan Commercial |
$1,451.84
|
| Rate for Payer: NAPHCARE Commercial |
$1,088.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,669.62
|
| Rate for Payer: Quartz Beloit One Network |
$889.25
|
| Rate for Payer: Quartz Commercial |
$1,179.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,088.88
|
| Rate for Payer: The Alliance Commercial |
$907.40
|
| Rate for Payer: WEA Trust Commercial |
$998.14
|
| Rate for Payer: WPS Commercial |
$1,344.17
|
|
|
INFUSION CATHETER MICROMEWI 10cm x 180cm 41067-0>>>>> Obsolete
|
Facility
|
OP
|
$3,134.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3505508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$912.62 |
| Max. Negotiated Rate |
$2,998.61 |
| Rate for Payer: Aetna Commercial |
$2,933.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.05
|
| Rate for Payer: Aetna Managed Medicare |
$912.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,118.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,629.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,564.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.46
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$2,998.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,823.99
|
| Rate for Payer: Health EOS Commercial |
$2,900.83
|
| Rate for Payer: HFN Commercial |
$2,998.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,444.52
|
| Rate for Payer: Multiplan Commercial |
$2,607.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,955.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,998.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.09
|
| Rate for Payer: Quartz Commercial |
$2,118.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,955.62
|
| Rate for Payer: The Alliance Commercial |
$1,629.68
|
| Rate for Payer: WEA Trust Commercial |
$1,792.65
|
| Rate for Payer: WPS Commercial |
$2,414.12
|
|
|
INFUSION CATHETER MICROMEWI 10cm x 180cm 41067-0>>>>> Obsolete
|
Facility
|
IP
|
$3,134.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
3505508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,597.09 |
| Max. Negotiated Rate |
$2,998.61 |
| Rate for Payer: Aetna Commercial |
$2,933.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,803.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,727.46
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$2,998.61
|
| Rate for Payer: Health EOS Commercial |
$2,900.83
|
| Rate for Payer: HFN Commercial |
$2,998.61
|
| Rate for Payer: Multiplan Commercial |
$2,607.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,998.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,597.09
|
| Rate for Payer: Quartz Commercial |
$1,955.62
|
| Rate for Payer: WEA Trust Commercial |
$1,792.65
|
| Rate for Payer: WPS Commercial |
$2,414.12
|
|
|
Infusion Pump Daily
|
Facility
|
IP
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$325.63 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$398.74
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
Infusion Pump Daily
|
Professional
|
Both
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$292.41 |
| Max. Negotiated Rate |
$631.33 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$631.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.74
|
| Rate for Payer: Health EOS Commercial |
$604.75
|
| Rate for Payer: HFN Commercial |
$631.33
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$631.33
|
| Rate for Payer: Quartz Beloit One Network |
$292.41
|
| Rate for Payer: Quartz Commercial |
$378.80
|
| Rate for Payer: The Alliance Commercial |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
Infusion Pump Daily
|
Facility
|
OP
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$186.08 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$186.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.42
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$398.74
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$431.96
|
| Rate for Payer: Quartz Medicare Advantage |
$398.74
|
| Rate for Payer: The Alliance Commercial |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
INFUSION SET FOR EPIDURAL 15ML 10011301
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
4089809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$42.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.66
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$91.73
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$91.73
|
| Rate for Payer: The Alliance Commercial |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
INFUSION SET FOR EPIDURAL 15ML 10011301
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
4089809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON W/ FILTER
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
4089808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.94
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON W/ FILTER
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
4089808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON WITHOUT TPN 2260-0500
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
4223894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON WITHOUT TPN 2260-0500
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
4223894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
INFUSION SET PUMP DEHP-FREE PRIMARY 25ML 2420-0007
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4089810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
INFUSION SET PUMP DEHP-FREE PRIMARY 25ML 2420-0007
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4089810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Ingest Challenge ini 120 min 95076
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
3873517
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$422.12 |
| Rate for Payer: Aetna Commercial |
$219.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$63.07
|
| Rate for Payer: Anthem Medicare Advantage |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.07
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$219.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.07
|
| Rate for Payer: Health EOS Commercial |
$210.10
|
| Rate for Payer: HFN Commercial |
$219.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.07
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$94.60
|
| Rate for Payer: Preferred Network Access Commercial |
$219.34
|
| Rate for Payer: Quartz Beloit One Network |
$101.59
|
| Rate for Payer: Quartz Commercial |
$131.60
|
| Rate for Payer: Quartz Medicare Advantage |
$63.07
|
| Rate for Payer: The Alliance Commercial |
$157.66
|
| Rate for Payer: United Healthcare Medicaid |
$57.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.07
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$252.26
|
|
|
Ingestion Challenge Test
|
Professional
|
Both
|
$309.00
|
|
| Hospital Charge Code |
1190801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$305.29 |
| Rate for Payer: Aetna Commercial |
$305.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$305.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.82
|
| Rate for Payer: Health EOS Commercial |
$292.44
|
| Rate for Payer: HFN Commercial |
$305.29
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$305.29
|
| Rate for Payer: Quartz Beloit One Network |
$141.40
|
| Rate for Payer: Quartz Commercial |
$183.18
|
| Rate for Payer: The Alliance Commercial |
$160.68
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$238.02
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$40,579.76
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$12,181.71 |
| Max. Negotiated Rate |
$40,579.76 |
| Rate for Payer: Aetna Managed Medicare |
$12,181.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,263.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,496.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,222.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,181.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,181.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,181.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,181.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,889.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,181.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,519.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,181.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,181.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,181.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,181.71
|
| Rate for Payer: NAPHCARE Commercial |
$18,272.56
|
| Rate for Payer: Quartz Medicare Advantage |
$12,181.71
|
| Rate for Payer: The Alliance Commercial |
$40,579.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,181.71
|
| Rate for Payer: United Healthcare PPO |
$22,981.36
|
| Rate for Payer: Wellcare Medicare |
$12,181.71
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$66,692.08
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$19,590.25 |
| Max. Negotiated Rate |
$66,692.08 |
| Rate for Payer: Aetna Managed Medicare |
$19,590.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54,371.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,675.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,594.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19,590.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,590.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,590.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,590.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,953.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,590.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,672.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,590.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,590.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,590.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,590.25
|
| Rate for Payer: NAPHCARE Commercial |
$29,385.38
|
| Rate for Payer: Quartz Medicare Advantage |
$19,590.25
|
| Rate for Payer: The Alliance Commercial |
$66,692.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,590.25
|
| Rate for Payer: United Healthcare PPO |
$37,891.78
|
| Rate for Payer: Wellcare Medicare |
$19,590.25
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,996.16
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$9,450.02 |
| Max. Negotiated Rate |
$30,996.16 |
| Rate for Payer: Aetna Managed Medicare |
$9,450.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,480.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,530.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,555.31
|
| Rate for Payer: Anthem Medicare Advantage |
$9,450.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,450.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,450.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,450.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,598.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,450.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,490.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,450.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,450.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,450.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,450.02
|
| Rate for Payer: NAPHCARE Commercial |
$14,175.03
|
| Rate for Payer: Quartz Medicare Advantage |
$9,450.02
|
| Rate for Payer: The Alliance Commercial |
$30,996.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,450.02
|
| Rate for Payer: United Healthcare PPO |
$17,509.16
|
| Rate for Payer: Wellcare Medicare |
$9,450.02
|
|
