|
Intrinsic Factor Antibody
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$268.74 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Medicare Advantage |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.68
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.68
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$23.52
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$15.68
|
| Rate for Payer: The Alliance Commercial |
$61.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.68
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$69.01
|
|
|
Intro Catheter Aorta
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3913416
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$712.42 |
| Max. Negotiated Rate |
$1,337.61 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$872.35
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
Intro Catheter Aorta
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$1,478.05 |
| Rate for Payer: Aetna Commercial |
$1,478.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.02
|
| Rate for Payer: Aetna Managed Medicare |
$112.40
|
| Rate for Payer: Anthem Medicare Advantage |
$112.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.40
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,478.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.40
|
| Rate for Payer: Health EOS Commercial |
$1,415.81
|
| Rate for Payer: HFN Commercial |
$1,478.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.40
|
| Rate for Payer: Multiplan Commercial |
$1,244.67
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,478.05
|
| Rate for Payer: Quartz Beloit One Network |
$684.57
|
| Rate for Payer: Quartz Commercial |
$886.83
|
| Rate for Payer: Quartz Medicare Advantage |
$112.40
|
| Rate for Payer: The Alliance Commercial |
$477.71
|
| Rate for Payer: United Healthcare Medicaid |
$251.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.40
|
| Rate for Payer: WEA Trust Commercial |
$855.71
|
| Rate for Payer: WPS Commercial |
$505.81
|
|
|
Intro Catheter Aorta
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$435.64 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,400.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.02
|
| Rate for Payer: Aetna Managed Medicare |
$435.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$777.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.60
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,431.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,384.70
|
| Rate for Payer: HFN Commercial |
$1,431.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,166.88
|
| Rate for Payer: Multiplan Commercial |
$1,244.67
|
| Rate for Payer: NAPHCARE Commercial |
$933.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.37
|
| Rate for Payer: Quartz Beloit One Network |
$762.36
|
| Rate for Payer: Quartz Commercial |
$1,011.30
|
| Rate for Payer: Quartz Medicare Advantage |
$933.50
|
| Rate for Payer: The Alliance Commercial |
$449.61
|
| Rate for Payer: WEA Trust Commercial |
$855.71
|
| Rate for Payer: WPS Commercial |
$1,152.37
|
|
|
Intro Catheter Aorta
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3913416
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$407.10 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Aetna Managed Medicare |
$407.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.44
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: NAPHCARE Commercial |
$872.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$945.05
|
| Rate for Payer: Quartz Medicare Advantage |
$872.35
|
| Rate for Payer: The Alliance Commercial |
$449.61
|
| Rate for Payer: United Healthcare PPO |
$1,090.44
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
Intro Catheter Aorta
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$762.36 |
| Max. Negotiated Rate |
$1,431.37 |
| Rate for Payer: Aetna Commercial |
$1,400.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.60
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,431.37
|
| Rate for Payer: Health EOS Commercial |
$1,384.70
|
| Rate for Payer: HFN Commercial |
$1,431.37
|
| Rate for Payer: Multiplan Commercial |
$1,244.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.37
|
| Rate for Payer: Quartz Beloit One Network |
$762.36
|
| Rate for Payer: Quartz Commercial |
$933.50
|
| Rate for Payer: WEA Trust Commercial |
$855.71
|
| Rate for Payer: WPS Commercial |
$1,152.37
|
|
|
Intro Cath Extremity Artery
|
Facility
|
OP
|
$2,694.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3913413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$290.78 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,521.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,409.51
|
| Rate for Payer: Aetna Managed Medicare |
$784.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,821.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,400.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,344.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,484.93
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$2,577.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,493.57
|
| Rate for Payer: HFN Commercial |
$2,577.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,101.32
|
| Rate for Payer: Multiplan Commercial |
$2,241.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,681.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,577.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,372.86
|
| Rate for Payer: Quartz Commercial |
$1,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,681.06
|
| Rate for Payer: The Alliance Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$1,540.97
|
| Rate for Payer: WPS Commercial |
$2,075.19
|
|
|
Intro Cath Extremity Artery
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3913413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,372.86 |
| Max. Negotiated Rate |
$2,577.62 |
| Rate for Payer: Aetna Commercial |
$2,521.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,409.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,484.93
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$2,577.62
|
| Rate for Payer: Health EOS Commercial |
$2,493.57
|
| Rate for Payer: HFN Commercial |
$2,577.62
|
| Rate for Payer: Multiplan Commercial |
$2,241.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,577.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,372.86
|
| Rate for Payer: Quartz Commercial |
$1,681.06
|
| Rate for Payer: WEA Trust Commercial |
$1,540.97
|
| Rate for Payer: WPS Commercial |
$2,075.19
|
|
|
Intro Cath IVC/SVC
|
Facility
|
IP
|
$10,327.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
3052416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,262.64 |
| Max. Negotiated Rate |
$9,880.87 |
| Rate for Payer: Aetna Commercial |
$9,666.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,236.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,692.24
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cigna Commercial |
$9,880.87
|
| Rate for Payer: Health EOS Commercial |
$9,558.67
|
| Rate for Payer: HFN Commercial |
$9,880.87
|
| Rate for Payer: Multiplan Commercial |
$8,592.06
|
| Rate for Payer: Preferred Network Access Commercial |
$9,880.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,262.64
|
| Rate for Payer: Quartz Commercial |
$6,444.05
|
| Rate for Payer: WEA Trust Commercial |
$5,907.04
|
| Rate for Payer: WPS Commercial |
$7,954.89
|
|
|
Intro Cath IVC/SVC
|
Facility
|
OP
|
$10,327.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
3052416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$9,880.87 |
| Rate for Payer: Aetna Commercial |
$9,666.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,236.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,007.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,981.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,370.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,155.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,692.24
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cigna Commercial |
$9,880.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$9,558.67
|
| Rate for Payer: HFN Commercial |
$9,880.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,055.06
|
| Rate for Payer: Multiplan Commercial |
$8,592.06
|
| Rate for Payer: NAPHCARE Commercial |
$6,444.05
|
| Rate for Payer: Preferred Network Access Commercial |
$9,880.87
|
| Rate for Payer: Quartz Beloit One Network |
$5,262.64
|
| Rate for Payer: Quartz Commercial |
$6,981.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,444.05
|
| Rate for Payer: The Alliance Commercial |
$354.76
|
| Rate for Payer: WEA Trust Commercial |
$5,907.04
|
| Rate for Payer: WPS Commercial |
$7,954.89
|
|
|
Intro Cath Renal Pelvis Perc
|
Facility
|
IP
|
$542.00
|
|
| Hospital Charge Code |
3052579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.75
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$518.59
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$338.21
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
Intro Cath Renal Pelvis Perc
|
Facility
|
OP
|
$542.00
|
|
| Hospital Charge Code |
3052579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.83 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Aetna Managed Medicare |
$157.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$366.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.75
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$518.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.44
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.76
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: NAPHCARE Commercial |
$338.21
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$366.39
|
| Rate for Payer: Quartz Medicare Advantage |
$338.21
|
| Rate for Payer: The Alliance Commercial |
$281.84
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
Intro Cath/Stent Renal Pelvis
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,568.38 |
| Max. Negotiated Rate |
$4,822.27 |
| Rate for Payer: Aetna Commercial |
$4,717.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,778.05
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,822.27
|
| Rate for Payer: Health EOS Commercial |
$4,665.02
|
| Rate for Payer: HFN Commercial |
$4,822.27
|
| Rate for Payer: Multiplan Commercial |
$4,193.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,822.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.38
|
| Rate for Payer: Quartz Commercial |
$3,144.96
|
| Rate for Payer: WEA Trust Commercial |
$2,882.88
|
| Rate for Payer: WPS Commercial |
$3,882.31
|
|
|
Intro Cath/Stent Renal Pelvis
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Commercial |
$4,717.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,407.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.97
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,778.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,822.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Health EOS Commercial |
$4,665.02
|
| Rate for Payer: HFN Commercial |
$4,822.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: Multiplan Commercial |
$4,193.28
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,822.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,568.38
|
| Rate for Payer: Quartz Commercial |
$3,407.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,882.88
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
| Rate for Payer: WPS Commercial |
$3,882.31
|
|
|
Intro Cath/Stent Renal Pelvis
|
Professional
|
Both
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.86 |
| Max. Negotiated Rate |
$4,979.52 |
| Rate for Payer: Aetna Commercial |
$4,979.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,507.78
|
| Rate for Payer: Aetna Managed Medicare |
$171.86
|
| Rate for Payer: Anthem Medicare Advantage |
$171.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.86
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,979.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$855.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.86
|
| Rate for Payer: Health EOS Commercial |
$4,769.86
|
| Rate for Payer: HFN Commercial |
$4,979.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$710.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$710.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.86
|
| Rate for Payer: Multiplan Commercial |
$4,193.28
|
| Rate for Payer: NAPHCARE Commercial |
$257.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,979.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,306.30
|
| Rate for Payer: Quartz Commercial |
$2,987.71
|
| Rate for Payer: Quartz Medicare Advantage |
$171.86
|
| Rate for Payer: The Alliance Commercial |
$730.40
|
| Rate for Payer: United Healthcare Medicaid |
$855.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.86
|
| Rate for Payer: WEA Trust Commercial |
$2,882.88
|
| Rate for Payer: WPS Commercial |
$773.37
|
|
|
Intro Cath Venous
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$210.54 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Aetna Managed Medicare |
$210.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.94
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: NAPHCARE Commercial |
$451.15
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$488.75
|
| Rate for Payer: Quartz Medicare Advantage |
$451.15
|
| Rate for Payer: The Alliance Commercial |
$375.96
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
Intro Cath Venous
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
4378728
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$368.44 |
| Max. Negotiated Rate |
$691.77 |
| Rate for Payer: Aetna Commercial |
$676.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$646.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$691.77
|
| Rate for Payer: Health EOS Commercial |
$669.21
|
| Rate for Payer: HFN Commercial |
$691.77
|
| Rate for Payer: Multiplan Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$691.77
|
| Rate for Payer: Quartz Beloit One Network |
$368.44
|
| Rate for Payer: Quartz Commercial |
$451.15
|
| Rate for Payer: WEA Trust Commercial |
$413.56
|
| Rate for Payer: WPS Commercial |
$556.93
|
|
|
INTRODUCER 7FR
|
Facility
|
OP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.27 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$325.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.09
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.26
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$697.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$755.09
|
| Rate for Payer: Quartz Medicare Advantage |
$697.01
|
| Rate for Payer: The Alliance Commercial |
$580.84
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER 7FR
|
Facility
|
IP
|
$1,117.00
|
|
| Hospital Charge Code |
2972040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.22 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.69
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,068.75
|
| Rate for Payer: Health EOS Commercial |
$1,033.90
|
| Rate for Payer: HFN Commercial |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.75
|
| Rate for Payer: Quartz Beloit One Network |
$569.22
|
| Rate for Payer: Quartz Commercial |
$697.01
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$860.43
|
|
|
INTRODUCER 7FR. RDC GUIDING 4037553A
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.77 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$765.02
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
INTRODUCER 7FR. RDC GUIDING 4037553A
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
2972130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.01 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Aetna Managed Medicare |
$357.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$713.53
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$956.28
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: NAPHCARE Commercial |
$765.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$828.78
|
| Rate for Payer: Quartz Medicare Advantage |
$765.02
|
| Rate for Payer: The Alliance Commercial |
$637.52
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
INTRODUCER 8fr. HS 403-8553H
|
Facility
|
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2972095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
INTRODUCER BOUGIE ADULT 9-0212-70
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
2963462
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
