|
INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE, IMMED TYPE 95027
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
CPT 95027
|
| Hospital Charge Code |
6219189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.80
|
| Rate for Payer: Health EOS Commercial |
$2.73
|
| Rate for Payer: HFN Commercial |
$2.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.53
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2.85
|
| Rate for Payer: Quartz Beloit One Network |
$1.32
|
| Rate for Payer: Quartz Commercial |
$1.71
|
| Rate for Payer: The Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Medicaid |
$4.83
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
INTRANASAL BIOPSY 30100
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
3014350
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$287.85 |
| Rate for Payer: Aetna Commercial |
$287.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.58
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$287.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.80
|
| Rate for Payer: Health EOS Commercial |
$275.73
|
| Rate for Payer: HFN Commercial |
$287.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$287.85
|
| Rate for Payer: Quartz Beloit One Network |
$133.32
|
| Rate for Payer: Quartz Commercial |
$172.71
|
| Rate for Payer: The Alliance Commercial |
$151.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$166.65
|
| Rate for Payer: WPS Commercial |
$224.43
|
|
|
INTRAOCULAR LENS IMPLANT, SECONDARY
|
Facility
|
IP
|
$5,256.00
|
|
| Hospital Charge Code |
2960367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,575.44 |
| Max. Negotiated Rate |
$4,835.52 |
| Rate for Payer: Aetna Commercial |
$4,730.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,520.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.68
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$4,835.52
|
| Rate for Payer: Health EOS Commercial |
$4,677.84
|
| Rate for Payer: HFN Commercial |
$4,835.52
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,835.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,575.44
|
| Rate for Payer: Quartz Commercial |
$3,153.60
|
| Rate for Payer: WEA Trust Commercial |
$2,890.80
|
| Rate for Payer: WPS Commercial |
$3,893.12
|
|
|
INTRAOCULAR LENS IMPLANT, SECONDARY
|
Facility
|
OP
|
$5,256.00
|
|
| Hospital Charge Code |
2960367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,471.68 |
| Max. Negotiated Rate |
$21,024.00 |
| Rate for Payer: Aetna Commercial |
$4,730.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,520.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,416.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,628.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,522.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.68
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$4,835.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.26
|
| Rate for Payer: Health EOS Commercial |
$4,677.84
|
| Rate for Payer: HFN Commercial |
$4,835.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,942.00
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,835.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,575.44
|
| Rate for Payer: Quartz Commercial |
$3,416.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,153.60
|
| Rate for Payer: The Alliance Commercial |
$21,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,890.80
|
| Rate for Payer: WPS Commercial |
$3,893.12
|
|
|
INTRAOCULAR LENS REPOSITIONING
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
INTRAOCULAR LENS REPOSITIONING
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$48,994.00
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$17,623.74 |
| Max. Negotiated Rate |
$48,994.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,623.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,393.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,428.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,958.74
|
| Rate for Payer: Anthem Medicare Advantage |
$17,623.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,623.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,623.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,623.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,036.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,623.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,700.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,623.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,623.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,623.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,623.74
|
| Rate for Payer: NAPHCARE Commercial |
$26,435.61
|
| Rate for Payer: Quartz Medicare Advantage |
$17,623.74
|
| Rate for Payer: The Alliance Commercial |
$48,994.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,623.74
|
| Rate for Payer: United Healthcare PPO |
$27,793.37
|
| Rate for Payer: Wellcare Medicare |
$17,623.74
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,181.00
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$11,575.92 |
| Max. Negotiated Rate |
$32,181.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,575.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,575.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,575.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,575.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,368.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,575.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,575.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,575.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,575.92
|
| Rate for Payer: NAPHCARE Commercial |
$17,363.88
|
| Rate for Payer: Quartz Medicare Advantage |
$11,575.92
|
| Rate for Payer: The Alliance Commercial |
$32,181.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,575.92
|
| Rate for Payer: United Healthcare PPO |
$18,192.91
|
| Rate for Payer: Wellcare Medicare |
$11,575.92
|
|
|
INTRAOCULAR RETINAL REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960158
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
INTRAOCULAR RETINAL REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960158
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTION OF NON-RADIOACTIVE DYE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 38900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
|
|
INTRAOP FEE NERVE ACTION
|
Facility
|
OP
|
$11,592.00
|
|
| Hospital Charge Code |
2967913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,245.76 |
| Max. Negotiated Rate |
$46,368.00 |
| Rate for Payer: Aetna Commercial |
$10,432.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,969.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,245.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,534.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,796.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,564.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,143.76
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: Cigna Commercial |
$10,664.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,486.88
|
| Rate for Payer: Health EOS Commercial |
$10,316.88
|
| Rate for Payer: HFN Commercial |
$10,664.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,694.00
|
| Rate for Payer: Multiplan Commercial |
$9,273.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,664.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,680.08
|
| Rate for Payer: Quartz Commercial |
$7,534.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,955.20
|
| Rate for Payer: The Alliance Commercial |
$46,368.00
|
| Rate for Payer: WEA Trust Commercial |
$6,375.60
|
| Rate for Payer: WPS Commercial |
$8,586.19
|
|
|
INTRAOP FEE NERVE ACTION
|
Facility
|
IP
|
$11,592.00
|
|
| Hospital Charge Code |
2967913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5,680.08 |
| Max. Negotiated Rate |
$10,664.64 |
| Rate for Payer: Aetna Commercial |
$10,432.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,969.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,143.76
|
| Rate for Payer: Cash Price |
$3,477.60
|
| Rate for Payer: Cigna Commercial |
$10,664.64
|
| Rate for Payer: Health EOS Commercial |
$10,316.88
|
| Rate for Payer: HFN Commercial |
$10,664.64
|
| Rate for Payer: Multiplan Commercial |
$9,273.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,664.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,680.08
|
| Rate for Payer: Quartz Commercial |
$6,955.20
|
| Rate for Payer: WEA Trust Commercial |
$6,375.60
|
| Rate for Payer: WPS Commercial |
$8,586.19
|
|
|
Intra Op TEE Ea Add HR
|
Professional
|
Both
|
$1,431.00
|
|
| Hospital Charge Code |
1158930
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$1,359.45 |
| Rate for Payer: Aetna Commercial |
$1,359.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,359.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$715.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.60
|
| Rate for Payer: Health EOS Commercial |
$1,302.21
|
| Rate for Payer: HFN Commercial |
$1,359.45
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.45
|
| Rate for Payer: Quartz Beloit One Network |
$629.64
|
| Rate for Payer: Quartz Commercial |
$815.67
|
| Rate for Payer: The Alliance Commercial |
$715.50
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
Intra Op TEE Ea Add HR
|
Facility
|
OP
|
$1,431.00
|
|
| Hospital Charge Code |
1158930
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$400.68 |
| Max. Negotiated Rate |
$5,724.00 |
| Rate for Payer: Aetna Commercial |
$1,287.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Aetna Managed Medicare |
$400.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.43
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,316.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.79
|
| Rate for Payer: Health EOS Commercial |
$1,273.59
|
| Rate for Payer: HFN Commercial |
$1,316.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.25
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: NAPHCARE Commercial |
$858.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.52
|
| Rate for Payer: Quartz Beloit One Network |
$701.19
|
| Rate for Payer: Quartz Commercial |
$930.15
|
| Rate for Payer: Quartz Medicare Advantage |
$858.60
|
| Rate for Payer: The Alliance Commercial |
$5,724.00
|
| Rate for Payer: United Healthcare PPO |
$1,073.25
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
Intra Op TEE Ea Add HR
|
Facility
|
IP
|
$1,431.00
|
|
| Hospital Charge Code |
1158930
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$701.19 |
| Max. Negotiated Rate |
$1,316.52 |
| Rate for Payer: Aetna Commercial |
$1,287.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.43
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,316.52
|
| Rate for Payer: Health EOS Commercial |
$1,273.59
|
| Rate for Payer: HFN Commercial |
$1,316.52
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: NAPHCARE Commercial |
$858.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.52
|
| Rate for Payer: Quartz Beloit One Network |
$701.19
|
| Rate for Payer: Quartz Commercial |
$858.60
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE 41009
|
Professional
|
Both
|
$1,724.00
|
|
|
Service Code
|
CPT 41009
|
| Hospital Charge Code |
6187325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$1,637.80 |
| Rate for Payer: Aetna Commercial |
$1,637.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.64
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$1,637.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.40
|
| Rate for Payer: Health EOS Commercial |
$1,568.84
|
| Rate for Payer: HFN Commercial |
$1,637.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$955.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$955.47
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.80
|
| Rate for Payer: Quartz Beloit One Network |
$758.56
|
| Rate for Payer: Quartz Commercial |
$982.68
|
| Rate for Payer: The Alliance Commercial |
$862.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.63
|
| Rate for Payer: WEA Trust Commercial |
$948.20
|
| Rate for Payer: WPS Commercial |
$1,276.97
|
|
|
Intraut copper contraceptive J7300 man
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
3373613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$937.00 |
| Max. Negotiated Rate |
$2,571.65 |
| Rate for Payer: Aetna Commercial |
$2,571.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Anthem Commercial |
$937.00
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,571.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,025.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.20
|
| Rate for Payer: Health EOS Commercial |
$2,463.37
|
| Rate for Payer: HFN Commercial |
$2,571.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,323.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,323.65
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,571.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.08
|
| Rate for Payer: Quartz Commercial |
$1,542.99
|
| Rate for Payer: The Alliance Commercial |
$1,353.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,025.00
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
Intraut copper contraceptive J7300 man
|
Facility
|
OP
|
$2,707.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
3373613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$757.96 |
| Max. Negotiated Rate |
$10,828.00 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Aetna Managed Medicare |
$757.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,759.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,299.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.84
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,030.25
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,759.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.20
|
| Rate for Payer: The Alliance Commercial |
$10,828.00
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
Intraut copper contraceptive J7300 man
|
Facility
|
IP
|
$2,707.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
3373613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,326.43 |
| Max. Negotiated Rate |
$2,490.44 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,624.20
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
INTRAVASC US, HEART ADD-ON 9297826
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
CPT 92978 26
|
| Hospital Charge Code |
3015352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.80
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$646.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.00
|
| Rate for Payer: Health EOS Commercial |
$618.80
|
| Rate for Payer: HFN Commercial |
$646.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.22
|
| Rate for Payer: Multiplan Commercial |
$544.00
|
| Rate for Payer: Preferred Network Access Commercial |
$646.00
|
| Rate for Payer: Quartz Beloit One Network |
$299.20
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: United Healthcare Medicaid |
$263.32
|
| Rate for Payer: WEA Trust Commercial |
$374.00
|
| Rate for Payer: WPS Commercial |
$503.68
|
|
|
INTRAVASC US, HEART ADD-ON 9297926
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 92979 26
|
| Hospital Charge Code |
3015354
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.20
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: HFN Commercial |
$538.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.88
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: The Alliance Commercial |
$283.50
|
| Rate for Payer: United Healthcare Medicaid |
$160.37
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
INTRAVENOUS CUTDOWN
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
INTRAVENOUS CUTDOWN
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Intravenous Infusion for therapy, prophylaxis or diagnosis; initial up to 1 Hr 96366
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
5516706
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$158.40
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
