|
Insertion of Pleural Catheter
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Commercial |
$1,799.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,719.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,299.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$999.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$959.52
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,059.47
|
| 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 |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,839.08
|
| 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 |
$1,779.11
|
| Rate for Payer: HFN Commercial |
$1,839.08
|
| 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 |
$1,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,839.08
|
| Rate for Payer: Quartz Beloit One Network |
$979.51
|
| Rate for Payer: Quartz Commercial |
$1,299.35
|
| 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 |
$1,099.45
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
| Rate for Payer: WPS Commercial |
$1,480.66
|
|
|
Insertion of Temporary Indwelling Bladder Catheter
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
1188972
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.20
|
| Rate for Payer: Health EOS Commercial |
$270.27
|
| Rate for Payer: HFN Commercial |
$282.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.30
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$282.15
|
| Rate for Payer: Quartz Beloit One Network |
$130.68
|
| Rate for Payer: Quartz Commercial |
$169.29
|
| Rate for Payer: The Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.76
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER (EG, DIALYSIS, INTRAPERITONEAL CHEMOTHERAPY INSTILLATION, MANAGEMENT OF ASCITES), COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETER PLACEMENT, CONTRAST INJECTION WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| 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: 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: 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: NAPHCARE Commercial |
$5,129.34
|
| 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 |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| 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: 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: 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: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
Insertion Opti Q Catheter
|
Facility
|
IP
|
$3,690.00
|
|
| Hospital Charge Code |
3101791
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,808.10 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Aetna Commercial |
$3,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,173.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.70
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$3,394.80
|
| Rate for Payer: Health EOS Commercial |
$3,284.10
|
| Rate for Payer: HFN Commercial |
$3,394.80
|
| Rate for Payer: Multiplan Commercial |
$2,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,394.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,808.10
|
| Rate for Payer: Quartz Commercial |
$2,214.00
|
| Rate for Payer: WEA Trust Commercial |
$2,029.50
|
| Rate for Payer: WPS Commercial |
$2,733.18
|
|
|
Insertion Opti Q Catheter
|
Facility
|
OP
|
$3,690.00
|
|
| Hospital Charge Code |
3101791
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,033.20 |
| Max. Negotiated Rate |
$14,760.00 |
| Rate for Payer: Aetna Commercial |
$3,321.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,173.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,398.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,845.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,771.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.70
|
| Rate for Payer: Cash Price |
$1,107.00
|
| Rate for Payer: Cigna Commercial |
$3,394.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,064.92
|
| Rate for Payer: Health EOS Commercial |
$3,284.10
|
| Rate for Payer: HFN Commercial |
$3,394.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,767.50
|
| Rate for Payer: Multiplan Commercial |
$2,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,214.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,394.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,808.10
|
| Rate for Payer: Quartz Commercial |
$2,398.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,214.00
|
| Rate for Payer: The Alliance Commercial |
$14,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,029.50
|
| Rate for Payer: WPS Commercial |
$2,733.18
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$114,175.10
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,757.59 |
| Max. Negotiated Rate |
$114,175.10 |
| Rate for Payer: Aetna Managed Medicare |
$30,692.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$30,692.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,692.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,692.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,692.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,692.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114,175.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,692.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,692.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,692.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,692.23
|
| Rate for Payer: NAPHCARE Commercial |
$46,038.34
|
| Rate for Payer: Quartz Medicare Advantage |
$30,692.23
|
| Rate for Payer: The Alliance Commercial |
$52,176.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,692.23
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: Wellcare Medicare |
$30,692.23
|
|
|
Insertion Pacing Swan-Ganz
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
3101789
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Aetna Managed Medicare |
$143.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.07
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$333.45
|
| Rate for Payer: Quartz Medicare Advantage |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
Insertion Pacing Swan-Ganz
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
3101789
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$471.96 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
Insertion Radial Artery
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3101788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.41 |
| Max. Negotiated Rate |
$1,204.28 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$785.40
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Insertion Radial Artery
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3101788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$5,236.00 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Aetna Managed Medicare |
$366.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.52
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.75
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$850.85
|
| Rate for Payer: Quartz Medicare Advantage |
$785.40
|
| Rate for Payer: The Alliance Commercial |
$5,236.00
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC 1806-1406S
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
5349003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$4,640.00 |
| Rate for Payer: Aetna Commercial |
$1,044.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.60
|
| Rate for Payer: Aetna Managed Medicare |
$324.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$754.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,067.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.14
|
| Rate for Payer: Health EOS Commercial |
$1,032.40
|
| Rate for Payer: HFN Commercial |
$1,067.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: NAPHCARE Commercial |
$696.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.20
|
| Rate for Payer: Quartz Beloit One Network |
$568.40
|
| Rate for Payer: Quartz Commercial |
$754.00
|
| Rate for Payer: Quartz Medicare Advantage |
$696.00
|
| Rate for Payer: The Alliance Commercial |
$4,640.00
|
| Rate for Payer: WEA Trust Commercial |
$638.00
|
| Rate for Payer: WPS Commercial |
$859.21
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC 1806-1406S
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
5349003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.40 |
| Max. Negotiated Rate |
$1,067.20 |
| Rate for Payer: Aetna Commercial |
$1,044.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.80
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,067.20
|
| Rate for Payer: Health EOS Commercial |
$1,032.40
|
| Rate for Payer: HFN Commercial |
$1,067.20
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: NAPHCARE Commercial |
$696.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.20
|
| Rate for Payer: Quartz Beloit One Network |
$568.40
|
| Rate for Payer: Quartz Commercial |
$696.00
|
| Rate for Payer: WEA Trust Commercial |
$638.00
|
| Rate for Payer: WPS Commercial |
$859.21
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC T2 1806-1407S
|
Facility
|
IP
|
$1,116.00
|
|
| Hospital Charge Code |
5685872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$1,026.72 |
| Rate for Payer: Aetna Commercial |
$1,004.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$959.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$591.48
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$1,026.72
|
| Rate for Payer: Health EOS Commercial |
$993.24
|
| Rate for Payer: HFN Commercial |
$1,026.72
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: NAPHCARE Commercial |
$669.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,026.72
|
| Rate for Payer: Quartz Beloit One Network |
$546.84
|
| Rate for Payer: Quartz Commercial |
$669.60
|
| Rate for Payer: WEA Trust Commercial |
$613.80
|
| Rate for Payer: WPS Commercial |
$826.62
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC T2 1806-1407S
|
Facility
|
OP
|
$1,116.00
|
|
| Hospital Charge Code |
5685872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.48 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$1,004.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$959.76
|
| Rate for Payer: Aetna Managed Medicare |
$312.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$725.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$558.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$591.48
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$1,026.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$624.51
|
| Rate for Payer: Health EOS Commercial |
$993.24
|
| Rate for Payer: HFN Commercial |
$1,026.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$837.00
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: NAPHCARE Commercial |
$669.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,026.72
|
| Rate for Payer: Quartz Beloit One Network |
$546.84
|
| Rate for Payer: Quartz Commercial |
$725.40
|
| Rate for Payer: Quartz Medicare Advantage |
$669.60
|
| Rate for Payer: The Alliance Commercial |
$4,464.00
|
| Rate for Payer: WEA Trust Commercial |
$613.80
|
| Rate for Payer: WPS Commercial |
$826.62
|
|
|
Insertion Subclavian Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101792
|
|
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 Subclavian Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101792
|
|
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 successful - Central IV Procedure Result:
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
3004358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.20 |
| Max. Negotiated Rate |
$8,460.00 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Aetna Managed Medicare |
$592.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.55
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.00
|
| Rate for Payer: The Alliance Commercial |
$8,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
Insertion successful - Central IV Procedure Result:
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
3004358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.35 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
Insertion Thermodilution Catheter
|
Facility
|
OP
|
$1,778.00
|
|
| Hospital Charge Code |
3101790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$7,112.00 |
| Rate for Payer: Aetna Commercial |
$1,600.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.08
|
| Rate for Payer: Aetna Managed Medicare |
$497.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$889.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.34
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,635.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.97
|
| Rate for Payer: Health EOS Commercial |
$1,582.42
|
| Rate for Payer: HFN Commercial |
$1,635.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.50
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.76
|
| Rate for Payer: Quartz Beloit One Network |
$871.22
|
| Rate for Payer: Quartz Commercial |
$1,155.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.80
|
| Rate for Payer: The Alliance Commercial |
$7,112.00
|
| Rate for Payer: WEA Trust Commercial |
$977.90
|
| Rate for Payer: WPS Commercial |
$1,316.96
|
|
|
Insertion Thermodilution Catheter
|
Facility
|
IP
|
$1,778.00
|
|
| Hospital Charge Code |
3101790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$871.22 |
| Max. Negotiated Rate |
$1,635.76 |
| Rate for Payer: Aetna Commercial |
$1,600.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.34
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,635.76
|
| Rate for Payer: Health EOS Commercial |
$1,582.42
|
| Rate for Payer: HFN Commercial |
$1,635.76
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.76
|
| Rate for Payer: Quartz Beloit One Network |
$871.22
|
| Rate for Payer: Quartz Commercial |
$1,066.80
|
| Rate for Payer: WEA Trust Commercial |
$977.90
|
| Rate for Payer: WPS Commercial |
$1,316.96
|
|
|
INSERT NASAL SEPTAL BUTTON 30220
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 30220
|
| Hospital Charge Code |
3014356
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$204.83 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Aetna Commercial |
$892.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$892.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.40
|
| Rate for Payer: Health EOS Commercial |
$854.49
|
| Rate for Payer: HFN Commercial |
$892.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$418.52
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$892.05
|
| Rate for Payer: Quartz Beloit One Network |
$413.16
|
| Rate for Payer: Quartz Commercial |
$535.23
|
| Rate for Payer: The Alliance Commercial |
$469.50
|
| Rate for Payer: United Healthcare Medicaid |
$204.83
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
INSERT NEEDLE W/O INJ 1 OR 2 MUSCL 20560
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 20560
|
| Hospital Charge Code |
5565248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$250.80 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$250.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.40
|
| Rate for Payer: Health EOS Commercial |
$240.24
|
| Rate for Payer: HFN Commercial |
$250.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.79
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.80
|
| Rate for Payer: Quartz Beloit One Network |
$116.16
|
| Rate for Payer: Quartz Commercial |
$150.48
|
| Rate for Payer: The Alliance Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
