|
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
|
Facility
|
OP
|
$895.40
|
|
|
Service Code
|
CPT 96365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$223.85 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Aetna Managed Medicare |
$223.85
|
| Rate for Payer: Anthem Medicare Advantage |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.85
|
| Rate for Payer: NAPHCARE Commercial |
$335.77
|
| Rate for Payer: Quartz Medicare Advantage |
$223.85
|
| Rate for Payer: The Alliance Commercial |
$895.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.85
|
| Rate for Payer: Wellcare Medicare |
$223.85
|
|
|
INTRAVENOUS INFUSION, HYDRATION; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$197.10
|
|
|
Service Code
|
CPT 96361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Managed Medicare |
$49.28
|
| Rate for Payer: Anthem Medicare Advantage |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.28
|
| Rate for Payer: NAPHCARE Commercial |
$73.91
|
| Rate for Payer: Quartz Medicare Advantage |
$49.28
|
| Rate for Payer: The Alliance Commercial |
$197.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.28
|
| Rate for Payer: Wellcare Medicare |
$49.28
|
|
|
Intravenous Injection
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3040224
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Intravenous Injection
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3040224
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.22 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$223.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Anthem Medicare Advantage |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.85
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.85
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$335.77
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| Rate for Payer: Quartz Medicare Advantage |
$223.85
|
| Rate for Payer: The Alliance Commercial |
$895.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.85
|
| Rate for Payer: United Healthcare PPO |
$272.22
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: Wellcare Medicare |
$223.85
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Intravenous Injection - 96374
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
5516710
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.22 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$223.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Anthem Medicare Advantage |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.85
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.85
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$335.77
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| Rate for Payer: Quartz Medicare Advantage |
$223.85
|
| Rate for Payer: The Alliance Commercial |
$895.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.85
|
| Rate for Payer: United Healthcare PPO |
$272.22
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: Wellcare Medicare |
$223.85
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Intravenous Injection - 96374
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
5516710
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
5516707
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$371.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$302.64
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
5516707
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.87
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$371.24
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$242.11
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
Intravitreal Injection Of Pharmacologic Agent
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
1188935
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$689.62 |
| Rate for Payer: Aetna Commercial |
$689.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$74.77
|
| Rate for Payer: Anthem Medicare Advantage |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.77
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$689.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.77
|
| Rate for Payer: Health EOS Commercial |
$660.59
|
| Rate for Payer: HFN Commercial |
$689.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.77
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$112.15
|
| Rate for Payer: Preferred Network Access Commercial |
$689.62
|
| Rate for Payer: Quartz Beloit One Network |
$319.40
|
| Rate for Payer: Quartz Commercial |
$413.77
|
| Rate for Payer: Quartz Medicare Advantage |
$74.77
|
| Rate for Payer: The Alliance Commercial |
$317.75
|
| Rate for Payer: United Healthcare Medicaid |
$177.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.77
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$336.45
|
|
|
Intrinsic Factor Antibody
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| 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 |
$260.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.68
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$23.52
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$15.68
|
| Rate for Payer: The Alliance Commercial |
$62.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.68
|
| Rate for Payer: United Healthcare PPO |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: Wellcare Medicare |
$15.68
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
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
|
|
|
Intrinsic Factor Antibody
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
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
|
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
|
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
|
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 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 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 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 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
|
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 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/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
|
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
|
|
