|
Androstenedione
|
Professional
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.28
|
| Rate for Payer: Anthem Medicare Advantage |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.28
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.28
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: Quartz Medicare Advantage |
$29.28
|
| Rate for Payer: The Alliance Commercial |
$115.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.28
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$128.83
|
|
|
Androstenedione
|
Facility
IP
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
Anesthesia Oxymeter Capnometer
|
Facility
OP
|
$839.00
|
|
| Hospital Charge Code |
3101748
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$234.92 |
| Max. Negotiated Rate |
$3,356.00 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$721.54
|
| Rate for Payer: Aetna Managed Medicare |
$234.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$545.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.50
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.25
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$545.35
|
| Rate for Payer: Quartz Medicare Advantage |
$503.40
|
| Rate for Payer: The Alliance Commercial |
$3,356.00
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
Anesthesia Oxymeter Capnometer
|
Facility
IP
|
$839.00
|
|
| Hospital Charge Code |
3101748
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$411.11 |
| Max. Negotiated Rate |
$771.88 |
| Rate for Payer: Aetna Commercial |
$755.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.67
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$771.88
|
| Rate for Payer: Health EOS Commercial |
$746.71
|
| Rate for Payer: HFN Commercial |
$771.88
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: NAPHCARE Commercial |
$503.40
|
| Rate for Payer: Preferred Network Access Commercial |
$771.88
|
| Rate for Payer: Quartz Beloit One Network |
$411.11
|
| Rate for Payer: Quartz Commercial |
$503.40
|
| Rate for Payer: WEA Trust Commercial |
$461.45
|
| Rate for Payer: WPS Commercial |
$621.45
|
|
|
ANEURYSM REPAIR, PSEUDO
|
Facility
IP
|
$15,504.00
|
|
| Hospital Charge Code |
2960327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,596.96 |
| Max. Negotiated Rate |
$14,263.68 |
| Rate for Payer: Aetna Commercial |
$13,953.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.12
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,263.68
|
| Rate for Payer: Health EOS Commercial |
$13,798.56
|
| Rate for Payer: HFN Commercial |
$14,263.68
|
| Rate for Payer: Multiplan Commercial |
$12,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,263.68
|
| Rate for Payer: Quartz Beloit One Network |
$7,596.96
|
| Rate for Payer: Quartz Commercial |
$9,302.40
|
| Rate for Payer: WEA Trust Commercial |
$8,527.20
|
| Rate for Payer: WPS Commercial |
$11,483.81
|
|
|
ANEURYSM REPAIR, PSEUDO
|
Facility
OP
|
$15,504.00
|
|
| Hospital Charge Code |
2960327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,341.12 |
| Max. Negotiated Rate |
$62,016.00 |
| Rate for Payer: Aetna Commercial |
$13,953.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,333.44
|
| Rate for Payer: Aetna Managed Medicare |
$4,341.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,077.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,752.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,441.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.12
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,263.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,676.04
|
| Rate for Payer: Health EOS Commercial |
$13,798.56
|
| Rate for Payer: HFN Commercial |
$14,263.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,628.00
|
| Rate for Payer: Multiplan Commercial |
$12,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,263.68
|
| Rate for Payer: Quartz Beloit One Network |
$7,596.96
|
| Rate for Payer: Quartz Commercial |
$10,077.60
|
| Rate for Payer: Quartz Medicare Advantage |
$9,302.40
|
| Rate for Payer: The Alliance Commercial |
$62,016.00
|
| Rate for Payer: WEA Trust Commercial |
$8,527.20
|
| Rate for Payer: WPS Commercial |
$11,483.81
|
|
|
ANGEL SYSTEM WITH ASPIRATION KIT ACDA ABS-10062T
|
Facility
OP
|
$8,444.00
|
|
| Hospital Charge Code |
5458899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,364.32 |
| Max. Negotiated Rate |
$33,776.00 |
| Rate for Payer: Aetna Commercial |
$7,599.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,261.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,364.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,488.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,222.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,053.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,475.32
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$7,768.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,725.26
|
| Rate for Payer: Health EOS Commercial |
$7,515.16
|
| Rate for Payer: HFN Commercial |
$7,768.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,333.00
|
| Rate for Payer: Multiplan Commercial |
$6,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,066.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,768.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.56
|
| Rate for Payer: Quartz Commercial |
$5,488.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,066.40
|
| Rate for Payer: The Alliance Commercial |
$33,776.00
|
| Rate for Payer: WEA Trust Commercial |
$4,644.20
|
| Rate for Payer: WPS Commercial |
$6,254.47
|
|
|
ANGEL SYSTEM WITH ASPIRATION KIT ACDA ABS-10062T
|
Facility
IP
|
$8,444.00
|
|
| Hospital Charge Code |
5458899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,137.56 |
| Max. Negotiated Rate |
$7,768.48 |
| Rate for Payer: Aetna Commercial |
$7,599.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,475.32
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$7,768.48
|
| Rate for Payer: Health EOS Commercial |
$7,515.16
|
| Rate for Payer: HFN Commercial |
$7,768.48
|
| Rate for Payer: Multiplan Commercial |
$6,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,066.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,768.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,137.56
|
| Rate for Payer: Quartz Commercial |
$5,066.40
|
| Rate for Payer: WEA Trust Commercial |
$4,644.20
|
| Rate for Payer: WPS Commercial |
$6,254.47
|
|
|
ANGINA PECTORIS
|
Facility
IP
|
$18,880.00
|
|
|
Service Code
|
MS-DRG 311
|
| Min. Negotiated Rate |
$6,791.40 |
| Max. Negotiated Rate |
$18,880.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,686.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,256.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,694.60
|
| Rate for Payer: Anthem Medicare Advantage |
$6,791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,791.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,871.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,791.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,612.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,791.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,187.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6,791.40
|
| Rate for Payer: The Alliance Commercial |
$18,880.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,791.40
|
| Rate for Payer: United Healthcare PPO |
$10,597.86
|
| Rate for Payer: Wellcare Medicare |
$6,791.40
|
|
|
Angio Abdominal S&I
|
Facility
OP
|
$5,487.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
3052537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.20 |
| Max. Negotiated Rate |
$11,814.49 |
| Rate for Payer: Aetna Commercial |
$4,938.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,718.82
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,814.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,451.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,979.01
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna Commercial |
$5,048.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$4,883.43
|
| Rate for Payer: HFN Commercial |
$5,048.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$4,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,688.63
|
| Rate for Payer: Quartz Commercial |
$3,566.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$72.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,017.85
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,064.22
|
|
|
Angio Abdominal S&I
|
Facility
IP
|
$5,487.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
3052537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,688.63 |
| Max. Negotiated Rate |
$5,048.04 |
| Rate for Payer: Aetna Commercial |
$4,938.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.11
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna Commercial |
$5,048.04
|
| Rate for Payer: Health EOS Commercial |
$4,883.43
|
| Rate for Payer: HFN Commercial |
$5,048.04
|
| Rate for Payer: Multiplan Commercial |
$4,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,688.63
|
| Rate for Payer: Quartz Commercial |
$3,292.20
|
| Rate for Payer: WEA Trust Commercial |
$3,017.85
|
| Rate for Payer: WPS Commercial |
$4,064.22
|
|
|
Angio Abd/Pelvis/LE S&I
|
Facility
IP
|
$11,358.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
3052538
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,565.42 |
| Max. Negotiated Rate |
$10,449.36 |
| Rate for Payer: Aetna Commercial |
$10,222.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,019.74
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cigna Commercial |
$10,449.36
|
| Rate for Payer: Health EOS Commercial |
$10,108.62
|
| Rate for Payer: HFN Commercial |
$10,449.36
|
| Rate for Payer: Multiplan Commercial |
$9,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,814.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,449.36
|
| Rate for Payer: Quartz Beloit One Network |
$5,565.42
|
| Rate for Payer: Quartz Commercial |
$6,814.80
|
| Rate for Payer: WEA Trust Commercial |
$6,246.90
|
| Rate for Payer: WPS Commercial |
$8,412.87
|
|
|
Angio Abd/Pelvis/LE S&I
|
Facility
OP
|
$11,358.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
3052538
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$11,719.97 |
| Rate for Payer: Aetna Commercial |
$10,222.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,767.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,382.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,451.84
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,019.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cigna Commercial |
$10,449.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$10,108.62
|
| Rate for Payer: HFN Commercial |
$10,449.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$9,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,449.36
|
| Rate for Payer: Quartz Beloit One Network |
$5,565.42
|
| Rate for Payer: Quartz Commercial |
$7,382.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$6,246.90
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,412.87
|
|
|
Angio Arch
|
Facility
IP
|
$3,170.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
3052418
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,553.30 |
| Max. Negotiated Rate |
$2,916.40 |
| Rate for Payer: Aetna Commercial |
$2,853.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.10
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$2,916.40
|
| Rate for Payer: Health EOS Commercial |
$2,821.30
|
| Rate for Payer: HFN Commercial |
$2,916.40
|
| Rate for Payer: Multiplan Commercial |
$2,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.30
|
| Rate for Payer: Quartz Commercial |
$1,902.00
|
| Rate for Payer: WEA Trust Commercial |
$1,743.50
|
| Rate for Payer: WPS Commercial |
$2,348.02
|
|
|
Angio Arch
|
Facility
OP
|
$3,170.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
3052418
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,553.30 |
| Max. Negotiated Rate |
$26,084.76 |
| Rate for Payer: Aetna Commercial |
$2,853.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,726.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$2,916.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$2,821.30
|
| Rate for Payer: HFN Commercial |
$2,916.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$2,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,916.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.30
|
| Rate for Payer: Quartz Commercial |
$2,060.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$26,084.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,743.50
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$2,348.02
|
|
|
Angio Carotid Bil w/wo Arch
|
Facility
IP
|
$19,467.00
|
|
|
Service Code
|
CPT 36222 50
|
| Hospital Charge Code |
5577888
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,538.83 |
| Max. Negotiated Rate |
$17,909.64 |
| Rate for Payer: Aetna Commercial |
$17,520.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,317.51
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cigna Commercial |
$17,909.64
|
| Rate for Payer: Health EOS Commercial |
$17,325.63
|
| Rate for Payer: HFN Commercial |
$17,909.64
|
| Rate for Payer: Multiplan Commercial |
$15,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,680.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,909.64
|
| Rate for Payer: Quartz Beloit One Network |
$9,538.83
|
| Rate for Payer: Quartz Commercial |
$11,680.20
|
| Rate for Payer: WEA Trust Commercial |
$10,706.85
|
| Rate for Payer: WPS Commercial |
$14,419.21
|
|
|
Angio Carotid Bil w/wo Arch
|
Facility
OP
|
$19,467.00
|
|
|
Service Code
|
CPT 36222 50
|
| Hospital Charge Code |
5577888
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,450.76 |
| Max. Negotiated Rate |
$77,868.00 |
| Rate for Payer: Aetna Commercial |
$17,520.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,741.62
|
| Rate for Payer: Aetna Managed Medicare |
$5,450.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,653.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,733.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,344.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,317.51
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cigna Commercial |
$17,909.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,893.73
|
| Rate for Payer: Health EOS Commercial |
$17,325.63
|
| Rate for Payer: HFN Commercial |
$17,909.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,600.25
|
| Rate for Payer: Multiplan Commercial |
$15,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,680.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,909.64
|
| Rate for Payer: Quartz Beloit One Network |
$9,538.83
|
| Rate for Payer: Quartz Commercial |
$12,653.55
|
| Rate for Payer: Quartz Medicare Advantage |
$11,680.20
|
| Rate for Payer: The Alliance Commercial |
$77,868.00
|
| Rate for Payer: WEA Trust Commercial |
$10,706.85
|
| Rate for Payer: WPS Commercial |
$14,419.21
|
|
|
Angio Carotid Selective Internal w/wo Arch
|
Facility
IP
|
$4,513.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
4163434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,211.37 |
| Max. Negotiated Rate |
$4,151.96 |
| Rate for Payer: Aetna Commercial |
$4,061.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,391.89
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cigna Commercial |
$4,151.96
|
| Rate for Payer: Health EOS Commercial |
$4,016.57
|
| Rate for Payer: HFN Commercial |
$4,151.96
|
| Rate for Payer: Multiplan Commercial |
$3,610.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,707.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,151.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,211.37
|
| Rate for Payer: Quartz Commercial |
$2,707.80
|
| Rate for Payer: WEA Trust Commercial |
$2,482.15
|
| Rate for Payer: WPS Commercial |
$3,342.78
|
|
|
Angio Carotid Selective Internal w/wo Arch
|
Facility
OP
|
$4,513.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
4163434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,211.37 |
| Max. Negotiated Rate |
$26,084.76 |
| Rate for Payer: Aetna Commercial |
$4,061.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,881.18
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,391.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cigna Commercial |
$4,151.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$4,016.57
|
| Rate for Payer: HFN Commercial |
$4,151.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$3,610.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,151.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,211.37
|
| Rate for Payer: Quartz Commercial |
$2,933.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$26,084.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,482.15
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$3,342.78
|
|
|
Angio Carotid Uni w/wo Arch
|
Facility
IP
|
$10,108.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
3052419
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,952.92 |
| Max. Negotiated Rate |
$9,299.36 |
| Rate for Payer: Aetna Commercial |
$9,097.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,357.24
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cigna Commercial |
$9,299.36
|
| Rate for Payer: Health EOS Commercial |
$8,996.12
|
| Rate for Payer: HFN Commercial |
$9,299.36
|
| Rate for Payer: Multiplan Commercial |
$8,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,064.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,299.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,952.92
|
| Rate for Payer: Quartz Commercial |
$6,064.80
|
| Rate for Payer: WEA Trust Commercial |
$5,559.40
|
| Rate for Payer: WPS Commercial |
$7,487.00
|
|
|
Angio Carotid Uni w/wo Arch
|
Facility
OP
|
$10,108.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
3052419
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$11,719.97 |
| Rate for Payer: Aetna Commercial |
$9,097.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,692.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,357.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cigna Commercial |
$9,299.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$8,996.12
|
| Rate for Payer: HFN Commercial |
$9,299.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,299.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,952.92
|
| Rate for Payer: Quartz Commercial |
$6,570.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$6,468.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$5,559.40
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,487.00
|
|
|
ANGIOCATH 14gGX 5.25 382269
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.16 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Aetna Managed Medicare |
$97.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.18
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$208.20
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$225.55
|
| Rate for Payer: Quartz Medicare Advantage |
$208.20
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
ANGIOCATH 14gGX 5.25 382269
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.03 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$208.20
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$208.20
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Angiocath #16
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
3040299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Angiocath #16
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
3040299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
