|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$27,883.23
|
|
|
Service Code
|
APR-DRG 1703
|
| Min. Negotiated Rate |
$24,767.62 |
| Max. Negotiated Rate |
$27,883.23 |
| Rate for Payer: Anthem Medicaid |
$26,699.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,699.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,699.73
|
| Rate for Payer: Dean Health Medicaid |
$26,699.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,767.62
|
| Rate for Payer: Managed Health Services Medicaid |
$27,883.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,699.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,699.73
|
| Rate for Payer: United Healthcare Medicaid |
$26,699.73
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$63,307.92
|
|
|
Service Code
|
MSDRG 243
|
| Min. Negotiated Rate |
$16,825.63 |
| Max. Negotiated Rate |
$63,307.92 |
| Rate for Payer: Aetna Managed Medicare |
$16,825.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,494.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,637.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,858.13
|
| Rate for Payer: Anthem Medicare Advantage |
$16,825.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,825.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,825.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,825.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,585.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,825.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,189.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,825.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,825.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,825.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,825.63
|
| Rate for Payer: NAPHCARE Commercial |
$25,238.44
|
| Rate for Payer: Quartz Medicare Advantage |
$16,825.63
|
| Rate for Payer: The Alliance Commercial |
$63,307.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,825.63
|
| Rate for Payer: United Healthcare PPO |
$35,959.30
|
| Rate for Payer: Wellcare Medicare |
$16,825.63
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$95,865.12
|
|
|
Service Code
|
MSDRG 242
|
| Min. Negotiated Rate |
$24,957.88 |
| Max. Negotiated Rate |
$95,865.12 |
| Rate for Payer: Aetna Managed Medicare |
$24,957.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,664.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,397.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,730.78
|
| Rate for Payer: Anthem Medicare Advantage |
$24,957.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,957.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,957.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,957.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,315.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,957.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,069.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,957.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,957.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,957.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,957.88
|
| Rate for Payer: NAPHCARE Commercial |
$37,436.82
|
| Rate for Payer: Quartz Medicare Advantage |
$24,957.88
|
| Rate for Payer: The Alliance Commercial |
$95,865.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,957.88
|
| Rate for Payer: United Healthcare PPO |
$54,549.94
|
| Rate for Payer: Wellcare Medicare |
$24,957.88
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$13,327.83
|
|
|
Service Code
|
APR-DRG 1711
|
| Min. Negotiated Rate |
$11,838.61 |
| Max. Negotiated Rate |
$13,327.83 |
| Rate for Payer: Anthem Medicaid |
$12,762.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,762.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,762.13
|
| Rate for Payer: Dean Health Medicaid |
$12,762.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,838.61
|
| Rate for Payer: Managed Health Services Medicaid |
$13,327.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,762.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,762.13
|
| Rate for Payer: United Healthcare Medicaid |
$12,762.13
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$16,133.69
|
|
|
Service Code
|
APR-DRG 1712
|
| Min. Negotiated Rate |
$14,330.95 |
| Max. Negotiated Rate |
$16,133.69 |
| Rate for Payer: Anthem Medicaid |
$15,448.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,448.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,448.90
|
| Rate for Payer: Dean Health Medicaid |
$15,448.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,330.95
|
| Rate for Payer: Managed Health Services Medicaid |
$16,133.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,448.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,448.90
|
| Rate for Payer: United Healthcare Medicaid |
$15,448.90
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$21,833.09
|
|
|
Service Code
|
APR-DRG 1713
|
| Min. Negotiated Rate |
$19,393.51 |
| Max. Negotiated Rate |
$21,833.09 |
| Rate for Payer: Anthem Medicaid |
$20,906.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,906.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,906.39
|
| Rate for Payer: Dean Health Medicaid |
$20,906.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,393.51
|
| Rate for Payer: Managed Health Services Medicaid |
$21,833.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,906.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,906.39
|
| Rate for Payer: United Healthcare Medicaid |
$20,906.39
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT AMI, HEART FAILURE OR SHOCK
|
Facility
|
IP
|
$33,494.94
|
|
|
Service Code
|
APR-DRG 1714
|
| Min. Negotiated Rate |
$29,752.30 |
| Max. Negotiated Rate |
$33,494.94 |
| Rate for Payer: Anthem Medicaid |
$32,073.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,073.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,073.25
|
| Rate for Payer: Dean Health Medicaid |
$32,073.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,752.30
|
| Rate for Payer: Managed Health Services Medicaid |
$33,494.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,073.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,073.25
|
| Rate for Payer: United Healthcare Medicaid |
$32,073.25
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$50,917.36
|
|
|
Service Code
|
MSDRG 244
|
| Min. Negotiated Rate |
$14,348.97 |
| Max. Negotiated Rate |
$50,917.36 |
| Rate for Payer: Aetna Managed Medicare |
$14,348.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,438.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,229.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,719.58
|
| Rate for Payer: Anthem Medicare Advantage |
$14,348.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,348.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,348.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,348.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,881.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,348.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,102.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,348.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,348.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,348.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,348.97
|
| Rate for Payer: NAPHCARE Commercial |
$21,523.46
|
| Rate for Payer: Quartz Medicare Advantage |
$14,348.97
|
| Rate for Payer: The Alliance Commercial |
$50,917.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,348.97
|
| Rate for Payer: United Healthcare PPO |
$28,884.59
|
| Rate for Payer: Wellcare Medicare |
$14,348.97
|
|
|
Permanent tear duct plug A4263
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS A4263
|
| Hospital Charge Code |
3292171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Permanent tear duct plug A4263
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS A4263
|
| Hospital Charge Code |
3292171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Permanent tear duct plug A4263
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS A4263
|
| Hospital Charge Code |
3292171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.59
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.55
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Perq cervicothoracic inject 22510
|
Professional
|
Both
|
$4,259.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
6181378
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$4,207.89 |
| Rate for Payer: Aetna Commercial |
$4,207.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,809.25
|
| Rate for Payer: Aetna Managed Medicare |
$366.75
|
| Rate for Payer: Anthem Medicare Advantage |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$366.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$366.75
|
| Rate for Payer: Cash Price |
$1,277.70
|
| Rate for Payer: Cash Price |
$1,277.70
|
| Rate for Payer: Cash Price |
$1,277.70
|
| Rate for Payer: Cigna Commercial |
$4,207.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,396.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.75
|
| Rate for Payer: Health EOS Commercial |
$4,030.72
|
| Rate for Payer: HFN Commercial |
$4,207.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,496.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,496.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$366.75
|
| Rate for Payer: Multiplan Commercial |
$3,543.49
|
| Rate for Payer: NAPHCARE Commercial |
$550.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,207.89
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.92
|
| Rate for Payer: Quartz Commercial |
$2,524.74
|
| Rate for Payer: Quartz Medicare Advantage |
$366.75
|
| Rate for Payer: The Alliance Commercial |
$1,558.67
|
| Rate for Payer: United Healthcare Medicaid |
$1,396.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.75
|
| Rate for Payer: WEA Trust Commercial |
$2,436.15
|
| Rate for Payer: WPS Commercial |
$1,650.36
|
|
|
Perq&ic allg test drugs/biol 95018
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
3529576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$14.92
|
| Rate for Payer: United Healthcare Medicaid |
$7.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Perq sacral augmt bilat inj 0201T
|
Professional
|
Both
|
$4,503.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
6181383
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,060.57 |
| Max. Negotiated Rate |
$6,683.27 |
| Rate for Payer: Aetna Commercial |
$4,448.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,027.48
|
| Rate for Payer: Cash Price |
$1,350.90
|
| Rate for Payer: Cash Price |
$1,350.90
|
| Rate for Payer: Cigna Commercial |
$4,448.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,341.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,809.87
|
| Rate for Payer: Health EOS Commercial |
$4,261.64
|
| Rate for Payer: HFN Commercial |
$4,448.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,683.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,683.27
|
| Rate for Payer: Multiplan Commercial |
$3,746.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,448.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,060.57
|
| Rate for Payer: Quartz Commercial |
$2,669.38
|
| Rate for Payer: The Alliance Commercial |
$2,341.56
|
| Rate for Payer: WEA Trust Commercial |
$2,575.72
|
| Rate for Payer: WPS Commercial |
$3,468.66
|
|
|
Perq sacral augmt unilat inj 0200T
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
6181382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,574.60 |
| Max. Negotiated Rate |
$6,683.27 |
| Rate for Payer: Aetna Commercial |
$3,399.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,077.63
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Cigna Commercial |
$3,399.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,789.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.18
|
| Rate for Payer: Health EOS Commercial |
$3,256.56
|
| Rate for Payer: HFN Commercial |
$3,399.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,683.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,683.27
|
| Rate for Payer: Multiplan Commercial |
$2,862.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,399.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.60
|
| Rate for Payer: Quartz Commercial |
$2,039.82
|
| Rate for Payer: The Alliance Commercial |
$1,789.32
|
| Rate for Payer: WEA Trust Commercial |
$1,968.25
|
| Rate for Payer: WPS Commercial |
$2,650.60
|
|
|
Perq vertebral augmentation Lumbar 22514
|
Professional
|
Both
|
$4,326.00
|
|
|
Service Code
|
CPT 22514
|
| Hospital Charge Code |
6181381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.48 |
| Max. Negotiated Rate |
$5,858.11 |
| Rate for Payer: Aetna Commercial |
$4,274.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,869.17
|
| Rate for Payer: Aetna Managed Medicare |
$401.48
|
| Rate for Payer: Anthem Medicare Advantage |
$401.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$401.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$401.48
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cash Price |
$1,297.80
|
| Rate for Payer: Cigna Commercial |
$4,274.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,858.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.48
|
| Rate for Payer: Health EOS Commercial |
$4,094.13
|
| Rate for Payer: HFN Commercial |
$4,274.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,629.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,629.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$401.48
|
| Rate for Payer: Multiplan Commercial |
$3,599.23
|
| Rate for Payer: NAPHCARE Commercial |
$602.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,274.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,979.58
|
| Rate for Payer: Quartz Commercial |
$2,564.45
|
| Rate for Payer: Quartz Medicare Advantage |
$401.48
|
| Rate for Payer: The Alliance Commercial |
$1,706.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,858.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.48
|
| Rate for Payer: WEA Trust Commercial |
$2,474.47
|
| Rate for Payer: WPS Commercial |
$1,806.67
|
|
|
Perq vertebral augmentation Thoracic 22513
|
Professional
|
Both
|
$4,664.00
|
|
|
Service Code
|
CPT 22513
|
| Hospital Charge Code |
6181380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$428.76 |
| Max. Negotiated Rate |
$5,880.56 |
| Rate for Payer: Aetna Commercial |
$4,608.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,171.48
|
| Rate for Payer: Aetna Managed Medicare |
$428.76
|
| Rate for Payer: Anthem Medicare Advantage |
$428.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$428.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$428.76
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cigna Commercial |
$4,608.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,880.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.76
|
| Rate for Payer: Health EOS Commercial |
$4,414.01
|
| Rate for Payer: HFN Commercial |
$4,608.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,746.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,746.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$428.76
|
| Rate for Payer: Multiplan Commercial |
$3,880.45
|
| Rate for Payer: NAPHCARE Commercial |
$643.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,608.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,134.25
|
| Rate for Payer: Quartz Commercial |
$2,764.82
|
| Rate for Payer: Quartz Medicare Advantage |
$428.76
|
| Rate for Payer: The Alliance Commercial |
$1,822.23
|
| Rate for Payer: United Healthcare Medicaid |
$5,880.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.76
|
| Rate for Payer: WEA Trust Commercial |
$2,667.81
|
| Rate for Payer: WPS Commercial |
$1,929.42
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 10MM 42-5224-004-10
|
Facility
|
OP
|
$8,446.00
|
|
| Hospital Charge Code |
3583494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 10MM 42-5224-004-10
|
Facility
|
IP
|
$8,446.00
|
|
| Hospital Charge Code |
3583494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 11MM 42-5224-004-11
|
Facility
|
IP
|
$8,446.00
|
|
| Hospital Charge Code |
3962666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 11MM 42-5224-004-11
|
Facility
|
OP
|
$8,446.00
|
|
| Hospital Charge Code |
3962666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 12MM 42-5224-004-12
|
Facility
|
OP
|
$8,446.00
|
|
| Hospital Charge Code |
3962670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 12MM 42-5224-004-12
|
Facility
|
IP
|
$8,446.00
|
|
| Hospital Charge Code |
3962670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 13MM 42-5224-004-13
|
Facility
|
OP
|
$8,446.00
|
|
| Hospital Charge Code |
3962671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.48 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,391.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.57
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,587.88
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,709.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.30
|
| Rate for Payer: The Alliance Commercial |
$4,391.92
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
|
PERSONA ARTICULAR SURFACE PS VE 3-5 CD 13MM 42-5224-004-13
|
Facility
|
IP
|
$8,446.00
|
|
| Hospital Charge Code |
3962671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.08 |
| Max. Negotiated Rate |
$8,081.13 |
| Rate for Payer: Aetna Commercial |
$7,905.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.44
|
| Rate for Payer: Cash Price |
$2,533.80
|
| Rate for Payer: Cigna Commercial |
$8,081.13
|
| Rate for Payer: Health EOS Commercial |
$7,817.62
|
| Rate for Payer: HFN Commercial |
$8,081.13
|
| Rate for Payer: Multiplan Commercial |
$7,027.07
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.08
|
| Rate for Payer: Quartz Commercial |
$5,270.30
|
| Rate for Payer: WEA Trust Commercial |
$4,831.11
|
| Rate for Payer: WPS Commercial |
$6,505.95
|
|
