|
Insertion Radial Artery
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3101788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Aetna Managed Medicare |
$381.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.84
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.02
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: NAPHCARE Commercial |
$816.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$884.88
|
| Rate for Payer: Quartz Medicare Advantage |
$816.82
|
| Rate for Payer: The Alliance Commercial |
$680.68
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$15,344.54
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$13,629.98 |
| Max. Negotiated Rate |
$15,344.54 |
| Rate for Payer: Anthem Medicaid |
$14,693.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,693.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,693.25
|
| Rate for Payer: Dean Health Medicaid |
$14,693.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,629.98
|
| Rate for Payer: Managed Health Services Medicaid |
$15,344.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,693.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,693.25
|
| Rate for Payer: United Healthcare Medicaid |
$14,693.25
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$28,058.59
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$24,923.39 |
| Max. Negotiated Rate |
$28,058.59 |
| Rate for Payer: Anthem Medicaid |
$26,867.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,867.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,867.65
|
| Rate for Payer: Dean Health Medicaid |
$26,867.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,923.39
|
| Rate for Payer: Managed Health Services Medicaid |
$28,058.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,867.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,867.65
|
| Rate for Payer: United Healthcare Medicaid |
$26,867.65
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$20,868.58
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$18,536.77 |
| Max. Negotiated Rate |
$20,868.58 |
| Rate for Payer: Anthem Medicaid |
$19,982.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,982.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,982.81
|
| Rate for Payer: Dean Health Medicaid |
$19,982.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,536.77
|
| Rate for Payer: Managed Health Services Medicaid |
$20,868.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,982.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,982.81
|
| Rate for Payer: United Healthcare Medicaid |
$19,982.81
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$39,632.76
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$35,204.29 |
| Max. Negotiated Rate |
$39,632.76 |
| Rate for Payer: Anthem Medicaid |
$37,950.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37,950.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37,950.55
|
| Rate for Payer: Dean Health Medicaid |
$37,950.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35,204.29
|
| Rate for Payer: Managed Health Services Medicaid |
$39,632.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,950.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37,950.55
|
| Rate for Payer: United Healthcare Medicaid |
$37,950.55
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC 1806-1406S
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
5349003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.79 |
| Max. Negotiated Rate |
$1,109.89 |
| Rate for Payer: Aetna Commercial |
$1,085.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.50
|
| Rate for Payer: Aetna Managed Medicare |
$337.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.39
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,109.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.12
|
| Rate for Payer: Health EOS Commercial |
$1,073.70
|
| Rate for Payer: HFN Commercial |
$1,109.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.80
|
| Rate for Payer: Multiplan Commercial |
$965.12
|
| Rate for Payer: NAPHCARE Commercial |
$723.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.89
|
| Rate for Payer: Quartz Beloit One Network |
$591.14
|
| Rate for Payer: Quartz Commercial |
$784.16
|
| Rate for Payer: Quartz Medicare Advantage |
$723.84
|
| Rate for Payer: The Alliance Commercial |
$603.20
|
| Rate for Payer: WEA Trust Commercial |
$663.52
|
| Rate for Payer: WPS Commercial |
$893.55
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC 1806-1406S
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
5349003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.14 |
| Max. Negotiated Rate |
$1,109.89 |
| Rate for Payer: Aetna Commercial |
$1,085.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.39
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,109.89
|
| Rate for Payer: Health EOS Commercial |
$1,073.70
|
| Rate for Payer: HFN Commercial |
$1,109.89
|
| Rate for Payer: Multiplan Commercial |
$965.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.89
|
| Rate for Payer: Quartz Beloit One Network |
$591.14
|
| Rate for Payer: Quartz Commercial |
$723.84
|
| Rate for Payer: WEA Trust Commercial |
$663.52
|
| Rate for Payer: WPS Commercial |
$893.55
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC T2 1806-1407S
|
Facility
|
OP
|
$1,116.00
|
|
| Hospital Charge Code |
5685872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.98 |
| Max. Negotiated Rate |
$1,067.79 |
| Rate for Payer: Aetna Commercial |
$1,044.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$998.15
|
| Rate for Payer: Aetna Managed Medicare |
$324.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$754.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.14
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$1,067.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.51
|
| Rate for Payer: Health EOS Commercial |
$1,032.97
|
| Rate for Payer: HFN Commercial |
$1,067.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.48
|
| Rate for Payer: Multiplan Commercial |
$928.51
|
| Rate for Payer: NAPHCARE Commercial |
$696.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.79
|
| Rate for Payer: Quartz Beloit One Network |
$568.71
|
| Rate for Payer: Quartz Commercial |
$754.42
|
| Rate for Payer: Quartz Medicare Advantage |
$696.38
|
| Rate for Payer: The Alliance Commercial |
$580.32
|
| Rate for Payer: WEA Trust Commercial |
$638.35
|
| Rate for Payer: WPS Commercial |
$859.65
|
|
|
INSERTION SLEEVE TIBIAL NAIL ELASTIC T2 1806-1407S
|
Facility
|
IP
|
$1,116.00
|
|
| Hospital Charge Code |
5685872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$1,067.79 |
| Rate for Payer: Aetna Commercial |
$1,044.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$998.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.14
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna Commercial |
$1,067.79
|
| Rate for Payer: Health EOS Commercial |
$1,032.97
|
| Rate for Payer: HFN Commercial |
$1,067.79
|
| Rate for Payer: Multiplan Commercial |
$928.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.79
|
| Rate for Payer: Quartz Beloit One Network |
$568.71
|
| Rate for Payer: Quartz Commercial |
$696.38
|
| Rate for Payer: WEA Trust Commercial |
$638.35
|
| Rate for Payer: WPS Commercial |
$859.65
|
|
|
Insertion Subclavian Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.58 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Aetna Managed Medicare |
$394.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.61
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.90
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: NAPHCARE Commercial |
$845.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$915.98
|
| Rate for Payer: Quartz Medicare Advantage |
$845.52
|
| Rate for Payer: The Alliance Commercial |
$704.60
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
Insertion Subclavian Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$690.51 |
| Max. Negotiated Rate |
$1,296.46 |
| Rate for Payer: Aetna Commercial |
$1,268.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.88
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: Health EOS Commercial |
$1,254.19
|
| Rate for Payer: HFN Commercial |
$1,296.46
|
| Rate for Payer: Multiplan Commercial |
$1,127.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.46
|
| Rate for Payer: Quartz Beloit One Network |
$690.51
|
| Rate for Payer: Quartz Commercial |
$845.52
|
| Rate for Payer: WEA Trust Commercial |
$775.06
|
| Rate for Payer: WPS Commercial |
$1,043.76
|
|
|
Insertion successful - Central IV Procedure Result:
|
Facility
|
IP
|
$2,115.00
|
|
| Hospital Charge Code |
3004358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.80 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,319.76
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
Insertion successful - Central IV Procedure Result:
|
Facility
|
OP
|
$2,115.00
|
|
| Hospital Charge Code |
3004358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.89 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Aetna Managed Medicare |
$615.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.93
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,649.70
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,429.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.76
|
| Rate for Payer: The Alliance Commercial |
$1,099.80
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
Insertion Thermodilution Catheter
|
Facility
|
IP
|
$1,778.00
|
|
| Hospital Charge Code |
3101790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$906.07 |
| Max. Negotiated Rate |
$1,701.19 |
| Rate for Payer: Aetna Commercial |
$1,664.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,590.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$980.03
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,701.19
|
| Rate for Payer: Health EOS Commercial |
$1,645.72
|
| Rate for Payer: HFN Commercial |
$1,701.19
|
| Rate for Payer: Multiplan Commercial |
$1,479.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.19
|
| Rate for Payer: Quartz Beloit One Network |
$906.07
|
| Rate for Payer: Quartz Commercial |
$1,109.47
|
| Rate for Payer: WEA Trust Commercial |
$1,017.02
|
| Rate for Payer: WPS Commercial |
$1,369.59
|
|
|
Insertion Thermodilution Catheter
|
Facility
|
OP
|
$1,778.00
|
|
| Hospital Charge Code |
3101790
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$517.75 |
| Max. Negotiated Rate |
$1,701.19 |
| Rate for Payer: Aetna Commercial |
$1,664.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,590.24
|
| Rate for Payer: Aetna Managed Medicare |
$517.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,201.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$924.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$887.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$980.03
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,701.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.80
|
| Rate for Payer: Health EOS Commercial |
$1,645.72
|
| Rate for Payer: HFN Commercial |
$1,701.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,386.84
|
| Rate for Payer: Multiplan Commercial |
$1,479.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,109.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.19
|
| Rate for Payer: Quartz Beloit One Network |
$906.07
|
| Rate for Payer: Quartz Commercial |
$1,201.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,109.47
|
| Rate for Payer: The Alliance Commercial |
$924.56
|
| Rate for Payer: WEA Trust Commercial |
$1,017.02
|
| Rate for Payer: WPS Commercial |
$1,369.59
|
|
|
INSERT NASAL SEPTAL BUTTON 30220
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 30220
|
| Hospital Charge Code |
3014356
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$927.73 |
| Rate for Payer: Aetna Commercial |
$927.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$112.77
|
| Rate for Payer: Anthem Medicare Advantage |
$112.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.77
|
| 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 |
$927.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.77
|
| Rate for Payer: Health EOS Commercial |
$888.67
|
| Rate for Payer: HFN Commercial |
$927.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$435.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.77
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$169.15
|
| Rate for Payer: Preferred Network Access Commercial |
$927.73
|
| Rate for Payer: Quartz Beloit One Network |
$429.69
|
| Rate for Payer: Quartz Commercial |
$556.64
|
| Rate for Payer: Quartz Medicare Advantage |
$112.77
|
| Rate for Payer: The Alliance Commercial |
$479.26
|
| Rate for Payer: United Healthcare Medicaid |
$213.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.77
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$507.45
|
|
|
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 |
$12.54 |
| Max. Negotiated Rate |
$260.83 |
| Rate for Payer: Aetna Commercial |
$260.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$12.54
|
| Rate for Payer: Anthem Medicare Advantage |
$12.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.54
|
| 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 |
$260.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.54
|
| Rate for Payer: Health EOS Commercial |
$249.85
|
| Rate for Payer: HFN Commercial |
$260.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.54
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$18.81
|
| Rate for Payer: Preferred Network Access Commercial |
$260.83
|
| Rate for Payer: Quartz Beloit One Network |
$120.81
|
| Rate for Payer: Quartz Commercial |
$156.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.54
|
| Rate for Payer: The Alliance Commercial |
$53.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.54
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$56.44
|
|
|
INSERT NEEDLE W/O INJ 3 OR MORE MUSCLES 20561
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 20561
|
| Hospital Charge Code |
5565249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$19.65
|
| Rate for Payer: Anthem Medicare Advantage |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.65
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.65
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$29.47
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: Quartz Medicare Advantage |
$19.65
|
| Rate for Payer: The Alliance Commercial |
$83.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.65
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$88.41
|
|
|
Insert new site - IABP Activity
|
Facility
|
IP
|
$12,061.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
3034566
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,146.29 |
| Max. Negotiated Rate |
$11,539.96 |
| Rate for Payer: Aetna Commercial |
$11,289.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,787.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,648.02
|
| Rate for Payer: Cash Price |
$3,618.30
|
| Rate for Payer: Cigna Commercial |
$11,539.96
|
| Rate for Payer: Health EOS Commercial |
$11,163.66
|
| Rate for Payer: HFN Commercial |
$11,539.96
|
| Rate for Payer: Multiplan Commercial |
$10,034.75
|
| Rate for Payer: Preferred Network Access Commercial |
$11,539.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,146.29
|
| Rate for Payer: Quartz Commercial |
$7,526.06
|
| Rate for Payer: WEA Trust Commercial |
$6,898.89
|
| Rate for Payer: WPS Commercial |
$9,290.59
|
|
|
Insert new site - IABP Activity
|
Facility
|
OP
|
$12,061.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
3034566
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$824.93 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$11,289.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,787.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,512.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,153.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,020.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,648.02
|
| Rate for Payer: Cash Price |
$3,618.30
|
| Rate for Payer: Cash Price |
$3,618.30
|
| Rate for Payer: Cigna Commercial |
$11,539.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$11,163.66
|
| Rate for Payer: HFN Commercial |
$11,539.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,407.58
|
| Rate for Payer: Multiplan Commercial |
$10,034.75
|
| Rate for Payer: NAPHCARE Commercial |
$7,526.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,539.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,146.29
|
| Rate for Payer: Quartz Commercial |
$8,153.24
|
| Rate for Payer: Quartz Medicare Advantage |
$7,526.06
|
| Rate for Payer: The Alliance Commercial |
$824.93
|
| Rate for Payer: United Healthcare PPO |
$9,407.58
|
| Rate for Payer: WEA Trust Commercial |
$6,898.89
|
| Rate for Payer: WPS Commercial |
$9,290.59
|
|
|
INSERT NON-TUNNEL CV CATH 36555
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
3014530
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$1,694.42 |
| Rate for Payer: Aetna Commercial |
$1,694.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,533.90
|
| Rate for Payer: Aetna Managed Medicare |
$78.00
|
| Rate for Payer: Anthem Medicare Advantage |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.00
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$1,694.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$1,623.08
|
| Rate for Payer: HFN Commercial |
$1,694.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$1,426.88
|
| Rate for Payer: NAPHCARE Commercial |
$117.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,694.42
|
| Rate for Payer: Quartz Beloit One Network |
$784.78
|
| Rate for Payer: Quartz Commercial |
$1,016.65
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$331.50
|
| Rate for Payer: United Healthcare Medicaid |
$257.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$980.98
|
| Rate for Payer: WPS Commercial |
$351.00
|
|
|
INSERT NON-TUNNEL CV CATH 36556
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
3014531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$749.89 |
| Rate for Payer: Aetna Commercial |
$749.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Aetna Managed Medicare |
$74.51
|
| Rate for Payer: Anthem Medicare Advantage |
$74.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.51
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$749.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.51
|
| Rate for Payer: Health EOS Commercial |
$718.32
|
| Rate for Payer: HFN Commercial |
$749.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.51
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: NAPHCARE Commercial |
$111.76
|
| Rate for Payer: Preferred Network Access Commercial |
$749.89
|
| Rate for Payer: Quartz Beloit One Network |
$347.32
|
| Rate for Payer: Quartz Commercial |
$449.94
|
| Rate for Payer: Quartz Medicare Advantage |
$74.51
|
| Rate for Payer: The Alliance Commercial |
$316.65
|
| Rate for Payer: United Healthcare Medicaid |
$219.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.51
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$335.28
|
|
|
Insert Non-Tunnel CV Cath 3655622
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
CPT 36556 22
|
| Hospital Charge Code |
5478734
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.33 |
| Max. Negotiated Rate |
$900.07 |
| Rate for Payer: Aetna Commercial |
$900.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$814.80
|
| Rate for Payer: Cash Price |
$273.30
|
| Rate for Payer: Cash Price |
$273.30
|
| Rate for Payer: Cash Price |
$273.30
|
| Rate for Payer: Cigna Commercial |
$900.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.46
|
| Rate for Payer: Health EOS Commercial |
$862.17
|
| Rate for Payer: HFN Commercial |
$900.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.49
|
| Rate for Payer: Multiplan Commercial |
$757.95
|
| Rate for Payer: Preferred Network Access Commercial |
$900.07
|
| Rate for Payer: Quartz Beloit One Network |
$416.87
|
| Rate for Payer: Quartz Commercial |
$540.04
|
| Rate for Payer: The Alliance Commercial |
$473.72
|
| Rate for Payer: United Healthcare Medicaid |
$219.33
|
| Rate for Payer: WEA Trust Commercial |
$521.09
|
| Rate for Payer: WPS Commercial |
$701.74
|
|
|
Insert Non-Tunnel CV Cath 3655626
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
CPT 36556 26
|
| Hospital Charge Code |
4163454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.33 |
| Max. Negotiated Rate |
$749.89 |
| Rate for Payer: Aetna Commercial |
$749.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$749.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.62
|
| Rate for Payer: Health EOS Commercial |
$718.32
|
| Rate for Payer: HFN Commercial |
$749.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.49
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$749.89
|
| Rate for Payer: Quartz Beloit One Network |
$347.32
|
| Rate for Payer: Quartz Commercial |
$449.94
|
| Rate for Payer: The Alliance Commercial |
$394.68
|
| Rate for Payer: United Healthcare Medicaid |
$219.33
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$584.66
|
|
|
INSERT OCTOBASE RETRACTOR 28707
|
Facility
|
IP
|
$986.00
|
|
| Hospital Charge Code |
2965340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.47 |
| Max. Negotiated Rate |
$943.40 |
| Rate for Payer: Aetna Commercial |
$922.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.48
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$943.40
|
| Rate for Payer: Health EOS Commercial |
$912.64
|
| Rate for Payer: HFN Commercial |
$943.40
|
| Rate for Payer: Multiplan Commercial |
$820.35
|
| Rate for Payer: Preferred Network Access Commercial |
$943.40
|
| Rate for Payer: Quartz Beloit One Network |
$502.47
|
| Rate for Payer: Quartz Commercial |
$615.26
|
| Rate for Payer: WEA Trust Commercial |
$563.99
|
| Rate for Payer: WPS Commercial |
$759.52
|
|
