|
Infusion Catheter 65CM/135CM
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139304
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$6,980.00 |
| Rate for Payer: Aetna Commercial |
$1,570.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.70
|
| Rate for Payer: Aetna Managed Medicare |
$488.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,134.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$872.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$837.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.85
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,605.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$976.50
|
| Rate for Payer: Health EOS Commercial |
$1,553.05
|
| Rate for Payer: HFN Commercial |
$1,605.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.75
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.40
|
| Rate for Payer: Quartz Beloit One Network |
$855.05
|
| Rate for Payer: Quartz Commercial |
$1,134.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,047.00
|
| Rate for Payer: The Alliance Commercial |
$6,980.00
|
| Rate for Payer: WEA Trust Commercial |
$959.75
|
| Rate for Payer: WPS Commercial |
$1,292.52
|
|
|
Infusion Catheter 65CM/135CM
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139304
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$855.05 |
| Max. Negotiated Rate |
$1,605.40 |
| Rate for Payer: Aetna Commercial |
$1,570.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.85
|
| Rate for Payer: Cash Price |
$523.50
|
| Rate for Payer: Cigna Commercial |
$1,605.40
|
| Rate for Payer: Health EOS Commercial |
$1,553.05
|
| Rate for Payer: HFN Commercial |
$1,605.40
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.40
|
| Rate for Payer: Quartz Beloit One Network |
$855.05
|
| Rate for Payer: Quartz Commercial |
$1,047.00
|
| Rate for Payer: WEA Trust Commercial |
$959.75
|
| Rate for Payer: WPS Commercial |
$1,292.52
|
|
|
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 |
$1,535.66 |
| Max. Negotiated Rate |
$2,883.28 |
| Rate for Payer: Aetna Commercial |
$2,820.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,695.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,661.02
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$2,883.28
|
| Rate for Payer: Health EOS Commercial |
$2,789.26
|
| Rate for Payer: HFN Commercial |
$2,883.28
|
| Rate for Payer: Multiplan Commercial |
$2,507.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,880.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,883.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,535.66
|
| Rate for Payer: Quartz Commercial |
$1,880.40
|
| Rate for Payer: WEA Trust Commercial |
$1,723.70
|
| Rate for Payer: WPS Commercial |
$2,321.35
|
|
|
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 |
$877.52 |
| Max. Negotiated Rate |
$12,536.00 |
| Rate for Payer: Aetna Commercial |
$2,820.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,695.24
|
| Rate for Payer: Aetna Managed Medicare |
$877.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,037.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,567.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,504.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,661.02
|
| Rate for Payer: Cash Price |
$940.20
|
| Rate for Payer: Cigna Commercial |
$2,883.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,753.79
|
| Rate for Payer: Health EOS Commercial |
$2,789.26
|
| Rate for Payer: HFN Commercial |
$2,883.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,350.50
|
| Rate for Payer: Multiplan Commercial |
$2,507.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,880.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,883.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,535.66
|
| Rate for Payer: Quartz Commercial |
$2,037.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.40
|
| Rate for Payer: The Alliance Commercial |
$12,536.00
|
| Rate for Payer: WEA Trust Commercial |
$1,723.70
|
| Rate for Payer: WPS Commercial |
$2,321.35
|
|
|
Infusion Pump Daily
|
Facility
|
OP
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$2,556.00 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Aetna Managed Medicare |
$178.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.58
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$415.35
|
| Rate for Payer: Quartz Medicare Advantage |
$383.40
|
| Rate for Payer: The Alliance Commercial |
$2,556.00
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
Infusion Pump Daily
|
Professional
|
Both
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Aetna Commercial |
$607.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$607.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.40
|
| Rate for Payer: Health EOS Commercial |
$581.49
|
| Rate for Payer: HFN Commercial |
$607.05
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Preferred Network Access Commercial |
$607.05
|
| Rate for Payer: Quartz Beloit One Network |
$281.16
|
| Rate for Payer: Quartz Commercial |
$364.23
|
| Rate for Payer: The Alliance Commercial |
$319.50
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
Infusion Pump Daily
|
Facility
|
IP
|
$639.00
|
|
| Hospital Charge Code |
3005222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$587.88 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$383.40
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
INFUSION SET FOR EPIDURAL 15ML 10011301
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
4089809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
INFUSION SET FOR EPIDURAL 15ML 10011301
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
4089809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON W/ FILTER
|
Facility
|
OP
|
$173.00
|
|
| Hospital Charge Code |
4089808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.44 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$48.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$112.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.81
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$112.45
|
| Rate for Payer: Quartz Medicare Advantage |
$103.80
|
| Rate for Payer: The Alliance Commercial |
$692.00
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
INFUSION SET LOW SORBING 0.2 MICRON W/ FILTER
|
Facility
|
IP
|
$173.00
|
|
| Hospital Charge Code |
4089808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$103.80
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
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 |
$41.44 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$41.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$88.80
|
| Rate for Payer: The Alliance Commercial |
$592.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
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 |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
INFUSION SET PUMP DEHP-FREE PRIMARY 25ML 2420-0007
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4089810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$29.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$64.20
|
| Rate for Payer: The Alliance Commercial |
$428.00
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
INFUSION SET PUMP DEHP-FREE PRIMARY 25ML 2420-0007
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4089810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
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 |
$55.44 |
| Max. Negotiated Rate |
$405.88 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| 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 |
$210.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.20
|
| Rate for Payer: Health EOS Commercial |
$202.02
|
| Rate for Payer: HFN Commercial |
$210.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$405.88
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Preferred Network Access Commercial |
$210.90
|
| Rate for Payer: Quartz Beloit One Network |
$97.68
|
| Rate for Payer: Quartz Commercial |
$126.54
|
| Rate for Payer: The Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Medicaid |
$55.44
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
Ingestion Challenge Test
|
Professional
|
Both
|
$309.00
|
|
| Hospital Charge Code |
1190801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.96 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.74
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$293.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.40
|
| Rate for Payer: Health EOS Commercial |
$281.19
|
| Rate for Payer: HFN Commercial |
$293.55
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$293.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.96
|
| Rate for Payer: Quartz Commercial |
$176.13
|
| Rate for Payer: The Alliance Commercial |
$154.50
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$39,019.00
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$14,035.59 |
| Max. Negotiated Rate |
$39,019.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,035.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,630.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,478.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,305.88
|
| Rate for Payer: Anthem Medicare Advantage |
$14,035.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,035.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,035.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,035.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,761.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,035.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,384.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,035.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,035.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,035.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,035.59
|
| Rate for Payer: NAPHCARE Commercial |
$21,053.38
|
| Rate for Payer: Quartz Medicare Advantage |
$14,035.59
|
| Rate for Payer: The Alliance Commercial |
$39,019.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,035.59
|
| Rate for Payer: United Healthcare PPO |
$22,097.46
|
| Rate for Payer: Wellcare Medicare |
$14,035.59
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$64,127.00
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$23,067.18 |
| Max. Negotiated Rate |
$64,127.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,067.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,352.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,594.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,667.20
|
| Rate for Payer: Anthem Medicare Advantage |
$23,067.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,067.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,067.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,067.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,703.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,067.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,800.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,067.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,067.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,067.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,067.18
|
| Rate for Payer: NAPHCARE Commercial |
$34,600.77
|
| Rate for Payer: Quartz Medicare Advantage |
$23,067.18
|
| Rate for Payer: The Alliance Commercial |
$64,127.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,067.18
|
| Rate for Payer: United Healthcare PPO |
$36,434.40
|
| Rate for Payer: Wellcare Medicare |
$23,067.18
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,804.00
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$10,720.96 |
| Max. Negotiated Rate |
$29,804.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,720.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,287.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,849.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,958.58
|
| Rate for Payer: Anthem Medicare Advantage |
$10,720.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,720.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,720.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,720.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,825.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,720.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,625.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,720.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,720.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,720.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,720.96
|
| Rate for Payer: NAPHCARE Commercial |
$16,081.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10,720.96
|
| Rate for Payer: The Alliance Commercial |
$29,804.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,720.96
|
| Rate for Payer: United Healthcare PPO |
$16,835.73
|
| Rate for Payer: Wellcare Medicare |
$10,720.96
|
|
|
Inhibin A
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
2942985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicaid |
$16.11
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Dean Health Medicaid |
$16.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicaid |
$16.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.11
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicaid |
$16.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$254.25
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WMAP Medicaid |
$16.11
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Inhibin A
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
2942985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Inhibin A
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
2942985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$322.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$322.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.40
|
| Rate for Payer: Health EOS Commercial |
$308.49
|
| Rate for Payer: HFN Commercial |
$322.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$322.05
|
| Rate for Payer: Quartz Beloit One Network |
$149.16
|
| Rate for Payer: Quartz Commercial |
$193.23
|
| Rate for Payer: The Alliance Commercial |
$169.50
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Inhibin A Level
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
5542684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicaid |
$16.11
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Dean Health Medicaid |
$16.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicaid |
$16.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.11
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicaid |
$16.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$99.75
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WMAP Medicaid |
$16.11
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Inhibin A Level
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
5542684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
