|
INSERTER COOK MEDICAL G55179
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
INSERTER COOK MEDICAL G55179
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
INSERTER TIGHTROPE BUTTON AR-2262
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Aetna Managed Medicare |
$193.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.61
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: NAPHCARE Commercial |
$415.58
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$450.22
|
| Rate for Payer: Quartz Medicare Advantage |
$415.58
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 61MM EVERGRIP61
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5496808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.39 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$415.58
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
IP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.39 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$415.58
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
INSERT FOGARTY-HYDRAGRIP SURGICAL CLAMP EVERGRIP 86MM EVERGRIP86
|
Facility
|
OP
|
$666.00
|
|
| Hospital Charge Code |
5520745
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.94 |
| Max. Negotiated Rate |
$637.23 |
| Rate for Payer: Aetna Commercial |
$623.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Aetna Managed Medicare |
$193.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.10
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$637.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.61
|
| Rate for Payer: Health EOS Commercial |
$616.45
|
| Rate for Payer: HFN Commercial |
$637.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.48
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: NAPHCARE Commercial |
$415.58
|
| Rate for Payer: Preferred Network Access Commercial |
$637.23
|
| Rate for Payer: Quartz Beloit One Network |
$339.39
|
| Rate for Payer: Quartz Commercial |
$450.22
|
| Rate for Payer: Quartz Medicare Advantage |
$415.58
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$513.02
|
|
|
Insertion Femoral Artery
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
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 Femoral Artery
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3101787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.07 |
| 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: 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: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$816.82
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Insertion Femor Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
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 Femor Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101794
|
|
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 GUIDE SYNTH 323.050
|
Facility
|
IP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,889.78 |
| Max. Negotiated Rate |
$7,303.25 |
| Rate for Payer: Aetna Commercial |
$7,144.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.31
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,303.25
|
| Rate for Payer: Health EOS Commercial |
$7,065.10
|
| Rate for Payer: HFN Commercial |
$7,303.25
|
| Rate for Payer: Multiplan Commercial |
$6,350.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,303.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.78
|
| Rate for Payer: Quartz Commercial |
$4,762.99
|
| Rate for Payer: WEA Trust Commercial |
$4,366.08
|
| Rate for Payer: WPS Commercial |
$5,879.70
|
|
|
INSERTION GUIDE SYNTH 323.050
|
Facility
|
OP
|
$7,633.00
|
|
| Hospital Charge Code |
2966609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,222.73 |
| Max. Negotiated Rate |
$7,303.25 |
| Rate for Payer: Aetna Commercial |
$7,144.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,222.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,159.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,969.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,810.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,207.31
|
| Rate for Payer: Cash Price |
$2,289.90
|
| Rate for Payer: Cigna Commercial |
$7,303.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,442.41
|
| Rate for Payer: Health EOS Commercial |
$7,065.10
|
| Rate for Payer: HFN Commercial |
$7,303.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,953.74
|
| Rate for Payer: Multiplan Commercial |
$6,350.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,303.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.78
|
| Rate for Payer: Quartz Commercial |
$5,159.91
|
| Rate for Payer: Quartz Medicare Advantage |
$4,762.99
|
| Rate for Payer: The Alliance Commercial |
$3,969.16
|
| Rate for Payer: WEA Trust Commercial |
$4,366.08
|
| Rate for Payer: WPS Commercial |
$5,879.70
|
|
|
Insertion Jugular Site
|
Facility
|
OP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
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 Jugular Site
|
Facility
|
IP
|
$1,355.00
|
|
| Hospital Charge Code |
3101793
|
|
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 KIT FIBERTAK 1.8MM PERCUTANEOUS AR-3610PK-3
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5804229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
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 |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
IP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$83,700.78 |
| Max. Negotiated Rate |
$157,152.49 |
| Rate for Payer: Aetna Commercial |
$153,736.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146,903.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90,533.50
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$157,152.49
|
| Rate for Payer: Health EOS Commercial |
$152,027.95
|
| Rate for Payer: HFN Commercial |
$157,152.49
|
| Rate for Payer: Multiplan Commercial |
$136,654.34
|
| Rate for Payer: Preferred Network Access Commercial |
$157,152.49
|
| Rate for Payer: Quartz Beloit One Network |
$83,700.78
|
| Rate for Payer: Quartz Commercial |
$102,490.75
|
| Rate for Payer: WEA Trust Commercial |
$93,949.86
|
| Rate for Payer: WPS Commercial |
$126,520.23
|
|
|
Insertion LVAD-IMPELLA
|
Facility
|
OP
|
$164,248.00
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
5128679
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,147.49 |
| Max. Negotiated Rate |
$157,152.49 |
| Rate for Payer: Aetna Commercial |
$153,736.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146,903.41
|
| Rate for Payer: Aetna Managed Medicare |
$47,829.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111,031.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85,408.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81,992.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90,533.50
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cash Price |
$49,274.40
|
| Rate for Payer: Cigna Commercial |
$157,152.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$152,027.95
|
| Rate for Payer: HFN Commercial |
$157,152.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128,113.44
|
| Rate for Payer: Multiplan Commercial |
$136,654.34
|
| Rate for Payer: NAPHCARE Commercial |
$102,490.75
|
| Rate for Payer: Preferred Network Access Commercial |
$157,152.49
|
| Rate for Payer: Quartz Beloit One Network |
$83,700.78
|
| Rate for Payer: Quartz Commercial |
$111,031.65
|
| Rate for Payer: Quartz Medicare Advantage |
$102,490.75
|
| Rate for Payer: The Alliance Commercial |
$1,147.49
|
| Rate for Payer: WEA Trust Commercial |
$93,949.86
|
| Rate for Payer: WPS Commercial |
$126,520.23
|
|
|
INSERTION OF CATHETER, VEIN 36510
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
3014529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna Commercial |
$666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$44.89
|
| Rate for Payer: Anthem Medicare Advantage |
$44.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.89
|
| 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 |
$666.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.89
|
| Rate for Payer: Health EOS Commercial |
$638.82
|
| Rate for Payer: HFN Commercial |
$666.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.89
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.33
|
| Rate for Payer: Preferred Network Access Commercial |
$666.90
|
| Rate for Payer: Quartz Beloit One Network |
$308.88
|
| Rate for Payer: Quartz Commercial |
$400.14
|
| Rate for Payer: Quartz Medicare Advantage |
$44.89
|
| Rate for Payer: The Alliance Commercial |
$190.77
|
| Rate for Payer: United Healthcare Medicaid |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.89
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$201.99
|
|
|
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 |
$51.45 |
| Max. Negotiated Rate |
$621.45 |
| Rate for Payer: Aetna Commercial |
$621.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Aetna Managed Medicare |
$51.45
|
| Rate for Payer: Anthem Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.45
|
| 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 |
$621.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.45
|
| Rate for Payer: Health EOS Commercial |
$595.29
|
| Rate for Payer: HFN Commercial |
$621.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$216.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: NAPHCARE Commercial |
$77.17
|
| Rate for Payer: Preferred Network Access Commercial |
$621.45
|
| Rate for Payer: Quartz Beloit One Network |
$287.83
|
| Rate for Payer: Quartz Commercial |
$372.87
|
| Rate for Payer: Quartz Medicare Advantage |
$51.45
|
| Rate for Payer: The Alliance Commercial |
$218.66
|
| Rate for Payer: United Healthcare Medicaid |
$372.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: WPS Commercial |
$231.52
|
|
|
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 |
$320.54 |
| Max. Negotiated Rate |
$601.83 |
| Rate for Payer: Aetna Commercial |
$588.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$601.83
|
| Rate for Payer: Health EOS Commercial |
$582.20
|
| Rate for Payer: HFN Commercial |
$601.83
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: Preferred Network Access Commercial |
$601.83
|
| Rate for Payer: Quartz Beloit One Network |
$320.54
|
| Rate for Payer: Quartz Commercial |
$392.50
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: WPS Commercial |
$484.52
|
|
|
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 |
$140.02 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$588.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.00
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cash Price |
$188.70
|
| Rate for Payer: Cigna Commercial |
$601.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$582.20
|
| Rate for Payer: HFN Commercial |
$601.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$523.33
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$601.83
|
| Rate for Payer: Quartz Beloit One Network |
$320.54
|
| Rate for Payer: Quartz Commercial |
$425.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$359.79
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$484.52
|
|
|
Insertion of interbody biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (list separately in addition to code for primary procedure)
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.86 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$815.86
|
|
