|
INSERTION GUIDE SYNTH 323.050
|
Facility
|
IP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,740.17 |
| Max. Negotiated Rate |
$7,022.36 |
| Rate for Payer: Aetna Commercial |
$6,869.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,564.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,045.49
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,022.36
|
| Rate for Payer: Health EOS Commercial |
$6,793.37
|
| Rate for Payer: HFN Commercial |
$7,022.36
|
| Rate for Payer: Multiplan Commercial |
$6,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,579.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,022.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,740.17
|
| Rate for Payer: Quartz Commercial |
$4,579.80
|
| Rate for Payer: WEA Trust Commercial |
$4,198.15
|
| Rate for Payer: WPS Commercial |
$5,653.76
|
|
|
Insertion Jugular Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.40 |
| Max. Negotiated Rate |
$5,420.00 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Aetna Managed Medicare |
$379.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.26
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.25
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$880.75
|
| Rate for Payer: Quartz Medicare Advantage |
$813.00
|
| Rate for Payer: The Alliance Commercial |
$5,420.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
Insertion Jugular Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$1,246.60 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$813.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
INSERTION KIT FIBERTAK 1.8MM PERCUTANEOUS AR-3610PK-3
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5804229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.98 |
| Max. Negotiated Rate |
$2,117.84 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,381.20
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
INSERTION KIT FIBERTAK 1.8MM PERCUTANEOUS AR-3610PK-3
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5804229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.56 |
| Max. Negotiated Rate |
$9,208.00 |
| Rate for Payer: Aetna Commercial |
$2,071.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.72
|
| Rate for Payer: Aetna Managed Medicare |
$644.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.06
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,117.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.20
|
| Rate for Payer: Health EOS Commercial |
$2,048.78
|
| Rate for Payer: HFN Commercial |
$2,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.50
|
| Rate for Payer: Multiplan Commercial |
$1,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,496.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.20
|
| Rate for Payer: The Alliance Commercial |
$9,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.10
|
| Rate for Payer: WPS Commercial |
$1,705.09
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
IP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$80,481.52 |
| Max. Negotiated Rate |
$151,108.16 |
| Rate for Payer: Aetna Commercial |
$147,823.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141,253.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87,051.44
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$151,108.16
|
| Rate for Payer: Health EOS Commercial |
$146,180.72
|
| Rate for Payer: HFN Commercial |
$151,108.16
|
| Rate for Payer: Multiplan Commercial |
$131,398.40
|
| Rate for Payer: NAPHCARE Commercial |
$98,548.80
|
| Rate for Payer: Preferred Network Access Commercial |
$151,108.16
|
| Rate for Payer: Quartz Beloit One Network |
$80,481.52
|
| Rate for Payer: Quartz Commercial |
$98,548.80
|
| Rate for Payer: WEA Trust Commercial |
$90,336.40
|
| Rate for Payer: WPS Commercial |
$121,658.49
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
OP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,874.87 |
| Max. Negotiated Rate |
$656,992.00 |
| Rate for Payer: Aetna Commercial |
$147,823.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141,253.28
|
| Rate for Payer: Aetna Managed Medicare |
$45,989.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106,761.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82,124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78,839.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87,051.44
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$151,108.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$146,180.72
|
| Rate for Payer: HFN Commercial |
$151,108.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123,186.00
|
| Rate for Payer: Multiplan Commercial |
$131,398.40
|
| Rate for Payer: NAPHCARE Commercial |
$98,548.80
|
| Rate for Payer: Preferred Network Access Commercial |
$151,108.16
|
| Rate for Payer: Quartz Beloit One Network |
$80,481.52
|
| Rate for Payer: Quartz Commercial |
$106,761.20
|
| Rate for Payer: Quartz Medicare Advantage |
$98,548.80
|
| Rate for Payer: The Alliance Commercial |
$656,992.00
|
| Rate for Payer: WEA Trust Commercial |
$90,336.40
|
| Rate for Payer: WPS Commercial |
$121,658.49
|
|
|
INSERTION OF CATHETER, VEIN 36510
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
3014529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.39 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.69
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: United Healthcare Medicaid |
$98.39
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Aetna Commercial |
$597.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$540.94
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$597.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.40
|
| Rate for Payer: Health EOS Commercial |
$572.39
|
| Rate for Payer: HFN Commercial |
$597.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.41
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: Preferred Network Access Commercial |
$597.55
|
| Rate for Payer: Quartz Beloit One Network |
$276.76
|
| Rate for Payer: Quartz Commercial |
$358.53
|
| Rate for Payer: The Alliance Commercial |
$314.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$345.95
|
| Rate for Payer: WPS Commercial |
$465.90
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$308.21 |
| Max. Negotiated Rate |
$578.68 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$540.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.37
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$578.68
|
| Rate for Payer: Health EOS Commercial |
$559.81
|
| Rate for Payer: HFN Commercial |
$578.68
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: NAPHCARE Commercial |
$377.40
|
| Rate for Payer: Preferred Network Access Commercial |
$578.68
|
| Rate for Payer: Quartz Beloit One Network |
$308.21
|
| Rate for Payer: Quartz Commercial |
$377.40
|
| Rate for Payer: WEA Trust Commercial |
$345.95
|
| Rate for Payer: WPS Commercial |
$465.90
|
|
|
Insertion of Drug Delivery Implant 11981 - Admin Insertion of Drug Delivery Implant Charge
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
3023773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$566.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$540.94
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$408.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$314.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$578.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$559.81
|
| Rate for Payer: HFN Commercial |
$578.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$578.68
|
| Rate for Payer: Quartz Beloit One Network |
$308.21
|
| Rate for Payer: Quartz Commercial |
$408.85
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$345.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$465.90
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$983.48 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$641.40
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$513.12 |
| Max. Negotiated Rate |
$9,213.40 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$694.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$534.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.12
|
| Rate for Payer: Anthem Medicare Advantage |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,303.35
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,303.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,303.35
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,568.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,303.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,303.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,303.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,303.35
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,455.02
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$694.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,303.35
|
| Rate for Payer: The Alliance Commercial |
$9,213.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,303.35
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: Wellcare Medicare |
$2,303.35
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$1,015.55 |
| Rate for Payer: Aetna Commercial |
$1,015.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,015.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.40
|
| Rate for Payer: Health EOS Commercial |
$972.79
|
| Rate for Payer: HFN Commercial |
$1,015.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.63
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.55
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$609.33
|
| Rate for Payer: The Alliance Commercial |
$534.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
Insertion Of Intrauterine Device
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
1188878
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$696.35 |
| Rate for Payer: Aetna Commercial |
$696.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$630.38
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$696.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.80
|
| Rate for Payer: Health EOS Commercial |
$667.03
|
| Rate for Payer: HFN Commercial |
$696.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.93
|
| Rate for Payer: Multiplan Commercial |
$586.40
|
| Rate for Payer: Preferred Network Access Commercial |
$696.35
|
| Rate for Payer: Quartz Beloit One Network |
$322.52
|
| Rate for Payer: Quartz Commercial |
$417.81
|
| Rate for Payer: The Alliance Commercial |
$366.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$403.15
|
| Rate for Payer: WPS Commercial |
$542.93
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna Commercial |
$905.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$905.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.80
|
| Rate for Payer: Health EOS Commercial |
$867.23
|
| Rate for Payer: HFN Commercial |
$905.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.93
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Preferred Network Access Commercial |
$905.35
|
| Rate for Payer: Quartz Beloit One Network |
$419.32
|
| Rate for Payer: Quartz Commercial |
$543.21
|
| Rate for Payer: The Alliance Commercial |
$476.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$466.97 |
| Max. Negotiated Rate |
$876.76 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$571.80
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$857.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Aetna Managed Medicare |
$266.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.09
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$876.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$848.17
|
| Rate for Payer: HFN Commercial |
$876.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: NAPHCARE Commercial |
$571.80
|
| Rate for Payer: Preferred Network Access Commercial |
$876.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.97
|
| Rate for Payer: Quartz Commercial |
$619.45
|
| Rate for Payer: Quartz Medicare Advantage |
$571.80
|
| Rate for Payer: The Alliance Commercial |
$3,812.00
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
Insertion Of Non-Biodegradable Drug Delivery Implant 11981
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
1188880
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.74
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cigna Commercial |
$436.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.40
|
| Rate for Payer: Health EOS Commercial |
$417.69
|
| Rate for Payer: HFN Commercial |
$436.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.41
|
| Rate for Payer: Multiplan Commercial |
$367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$436.05
|
| Rate for Payer: Quartz Beloit One Network |
$201.96
|
| Rate for Payer: Quartz Commercial |
$261.63
|
| Rate for Payer: The Alliance Commercial |
$229.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$252.45
|
| Rate for Payer: WPS Commercial |
$339.98
|
|
|
Insertion of Non-Indwelling Bladder Catheter
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
1188971
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$293.02
|
| Rate for Payer: HFN Commercial |
$305.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.65
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$305.90
|
| Rate for Payer: Quartz Beloit One Network |
$141.68
|
| Rate for Payer: Quartz Commercial |
$183.54
|
| Rate for Payer: The Alliance Commercial |
$161.00
|
| Rate for Payer: United Healthcare Medicaid |
$57.49
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Insertion of Peritoneal Catheter
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Commercial |
$1,821.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,315.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$971.52
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,862.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Health EOS Commercial |
$1,801.36
|
| Rate for Payer: HFN Commercial |
$1,862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.08
|
| Rate for Payer: Quartz Beloit One Network |
$991.76
|
| Rate for Payer: Quartz Commercial |
$1,315.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
Insertion of Peritoneal Catheter
|
Professional
|
Both
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.72 |
| Max. Negotiated Rate |
$1,922.80 |
| Rate for Payer: Aetna Commercial |
$1,922.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,922.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,214.40
|
| Rate for Payer: Health EOS Commercial |
$1,841.84
|
| Rate for Payer: HFN Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$676.03
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,922.80
|
| Rate for Payer: Quartz Beloit One Network |
$890.56
|
| Rate for Payer: Quartz Commercial |
$1,153.68
|
| Rate for Payer: The Alliance Commercial |
$1,012.00
|
| Rate for Payer: United Healthcare Medicaid |
$164.72
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
Insertion of Peritoneal Catheter
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$991.76 |
| Max. Negotiated Rate |
$1,862.08 |
| Rate for Payer: Aetna Commercial |
$1,821.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,740.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,072.72
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,862.08
|
| Rate for Payer: Health EOS Commercial |
$1,801.36
|
| Rate for Payer: HFN Commercial |
$1,862.08
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.08
|
| Rate for Payer: Quartz Beloit One Network |
$991.76
|
| Rate for Payer: Quartz Commercial |
$1,214.40
|
| Rate for Payer: WEA Trust Commercial |
$1,113.20
|
| Rate for Payer: WPS Commercial |
$1,499.18
|
|
|
Insertion of Pleural Catheter
|
Professional
|
Both
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$617.69 |
| Max. Negotiated Rate |
$1,899.05 |
| Rate for Payer: Aetna Commercial |
$1,899.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.14
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,899.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$617.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,199.40
|
| Rate for Payer: Health EOS Commercial |
$1,819.09
|
| Rate for Payer: HFN Commercial |
$1,899.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$680.83
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,899.05
|
| Rate for Payer: Quartz Beloit One Network |
$879.56
|
| Rate for Payer: Quartz Commercial |
$1,139.43
|
| Rate for Payer: The Alliance Commercial |
$999.50
|
| Rate for Payer: United Healthcare Medicaid |
$617.69
|
| Rate for Payer: WEA Trust Commercial |
$1,099.45
|
| Rate for Payer: WPS Commercial |
$1,480.66
|
|
|
Insertion of Pleural Catheter
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$979.51 |
| Max. Negotiated Rate |
$1,839.08 |
| Rate for Payer: Aetna Commercial |
$1,799.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.47
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,839.08
|
| Rate for Payer: Health EOS Commercial |
$1,779.11
|
| Rate for Payer: HFN Commercial |
$1,839.08
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,199.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,839.08
|
| Rate for Payer: Quartz Beloit One Network |
$979.51
|
| Rate for Payer: Quartz Commercial |
$1,199.40
|
| Rate for Payer: WEA Trust Commercial |
$1,099.45
|
| Rate for Payer: WPS Commercial |
$1,480.66
|
|
