|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Aetna Managed Medicare |
$174.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$405.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$312.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$299.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.19
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: Quartz Medicare Advantage |
$374.40
|
| Rate for Payer: The Alliance Commercial |
$2,496.00
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$103,926.00
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$37,383.43 |
| Max. Negotiated Rate |
$103,926.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,383.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,822.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,715.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,584.20
|
| Rate for Payer: Anthem Medicare Advantage |
$37,383.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,383.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,383.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,383.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66,143.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,383.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,991.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,383.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,383.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,383.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,383.43
|
| Rate for Payer: NAPHCARE Commercial |
$56,075.14
|
| Rate for Payer: Quartz Medicare Advantage |
$37,383.43
|
| Rate for Payer: The Alliance Commercial |
$103,926.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,383.43
|
| Rate for Payer: United Healthcare PPO |
$59,160.36
|
| Rate for Payer: Wellcare Medicare |
$37,383.43
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$86,480.00
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$31,107.99 |
| Max. Negotiated Rate |
$86,480.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,107.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,975.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,500.72
|
| Rate for Payer: Anthem Medicare Advantage |
$31,107.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,107.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,107.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,107.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,950.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,107.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,195.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,107.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,107.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,107.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,107.99
|
| Rate for Payer: NAPHCARE Commercial |
$46,661.98
|
| Rate for Payer: Quartz Medicare Advantage |
$31,107.99
|
| Rate for Payer: The Alliance Commercial |
$86,480.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,107.99
|
| Rate for Payer: United Healthcare PPO |
$49,198.58
|
| Rate for Payer: Wellcare Medicare |
$31,107.99
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$76,747.00
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$27,606.86 |
| Max. Negotiated Rate |
$76,747.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,606.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,212.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,152.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,847.86
|
| Rate for Payer: Anthem Medicare Advantage |
$27,606.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,606.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,606.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,606.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,675.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,606.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,056.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,606.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,606.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,606.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,606.86
|
| Rate for Payer: NAPHCARE Commercial |
$41,410.29
|
| Rate for Payer: Quartz Medicare Advantage |
$27,606.86
|
| Rate for Payer: The Alliance Commercial |
$76,747.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,606.86
|
| Rate for Payer: United Healthcare PPO |
$43,640.82
|
| Rate for Payer: Wellcare Medicare |
$27,606.86
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$48,797.00
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$17,552.97 |
| Max. Negotiated Rate |
$48,797.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,552.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,183.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,267.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,805.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17,552.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,552.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,552.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,552.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,867.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,552.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,556.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,552.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,552.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,552.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,552.97
|
| Rate for Payer: NAPHCARE Commercial |
$26,329.46
|
| Rate for Payer: Quartz Medicare Advantage |
$17,552.97
|
| Rate for Payer: The Alliance Commercial |
$48,797.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,552.97
|
| Rate for Payer: United Healthcare PPO |
$27,681.04
|
| Rate for Payer: Wellcare Medicare |
$17,552.97
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$62,819.00
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$22,596.65 |
| Max. Negotiated Rate |
$62,819.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,596.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,303.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,790.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,903.30
|
| Rate for Payer: Anthem Medicare Advantage |
$22,596.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,596.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,596.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,596.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,855.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,596.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,840.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,596.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,596.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,596.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,596.65
|
| Rate for Payer: NAPHCARE Commercial |
$33,894.98
|
| Rate for Payer: Quartz Medicare Advantage |
$22,596.65
|
| Rate for Payer: The Alliance Commercial |
$62,819.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,596.65
|
| Rate for Payer: United Healthcare PPO |
$35,687.49
|
| Rate for Payer: Wellcare Medicare |
$22,596.65
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$42,510.00
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$15,291.26 |
| Max. Negotiated Rate |
$42,510.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,291.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,358.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,568.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,292.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,291.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,291.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,291.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,291.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,291.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,944.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,291.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,291.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,291.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$22,936.89
|
| Rate for Payer: Quartz Medicare Advantage |
$15,291.26
|
| Rate for Payer: The Alliance Commercial |
$42,510.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,291.26
|
| Rate for Payer: United Healthcare PPO |
$24,090.73
|
| Rate for Payer: Wellcare Medicare |
$15,291.26
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,428.93 |
| Max. Negotiated Rate |
$4,560.44 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$2,974.20
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,387.96 |
| Max. Negotiated Rate |
$19,828.00 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,222.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,478.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,379.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,773.94
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,717.75
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$3,222.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,974.20
|
| Rate for Payer: The Alliance Commercial |
$19,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$27,039.44
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,757.59 |
| Max. Negotiated Rate |
$27,039.44 |
| Rate for Payer: Aetna Managed Medicare |
$6,759.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,759.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,759.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,759.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,146.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,759.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,759.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,759.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,759.86
|
| Rate for Payer: NAPHCARE Commercial |
$10,139.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,759.86
|
| Rate for Payer: The Alliance Commercial |
$27,039.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,759.86
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$6,759.86
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
IP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,578.78 |
| Max. Negotiated Rate |
$2,964.24 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$1,933.20
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
OP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.16 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Aetna Managed Medicare |
$902.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,094.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,611.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,546.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,803.03
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,416.50
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$2,094.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,933.20
|
| Rate for Payer: The Alliance Commercial |
$12,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
OP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.92 |
| Max. Negotiated Rate |
$8,656.00 |
| Rate for Payer: Aetna Commercial |
$1,947.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.04
|
| Rate for Payer: Aetna Managed Medicare |
$605.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,406.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,082.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,038.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.92
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$1,990.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,210.97
|
| Rate for Payer: Health EOS Commercial |
$1,925.96
|
| Rate for Payer: HFN Commercial |
$1,990.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,623.00
|
| Rate for Payer: Multiplan Commercial |
$1,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.36
|
| Rate for Payer: Quartz Commercial |
$1,406.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,298.40
|
| Rate for Payer: The Alliance Commercial |
$8,656.00
|
| Rate for Payer: WEA Trust Commercial |
$1,190.20
|
| Rate for Payer: WPS Commercial |
$1,602.87
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
IP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.36 |
| Max. Negotiated Rate |
$1,990.88 |
| Rate for Payer: Aetna Commercial |
$1,947.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.92
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$1,990.88
|
| Rate for Payer: Health EOS Commercial |
$1,925.96
|
| Rate for Payer: HFN Commercial |
$1,990.88
|
| Rate for Payer: Multiplan Commercial |
$1,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.36
|
| Rate for Payer: Quartz Commercial |
$1,298.40
|
| Rate for Payer: WEA Trust Commercial |
$1,190.20
|
| Rate for Payer: WPS Commercial |
$1,602.87
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$218.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.49
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$507.00
|
| Rate for Payer: Quartz Medicare Advantage |
$468.00
|
| Rate for Payer: The Alliance Commercial |
$3,120.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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 |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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 |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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 |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S);
|
Facility
|
OP
|
$22,597.64
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$22,597.64 |
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$40,449.87
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,596.00 |
| Max. Negotiated Rate |
$40,449.87 |
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$18,485.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
|
|
PERCUTANEOUS ULTRASONIC LITHOTRIPSY WITH LITHOCLAST
|
Facility
|
IP
|
$17,872.00
|
|
|
Service Code
|
CPT 50081
|
| Hospital Charge Code |
5433010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,757.28 |
| Max. Negotiated Rate |
$16,442.24 |
| Rate for Payer: Aetna Commercial |
$16,084.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,369.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,472.16
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cigna Commercial |
$16,442.24
|
| Rate for Payer: Health EOS Commercial |
$15,906.08
|
| Rate for Payer: HFN Commercial |
$16,442.24
|
| Rate for Payer: Multiplan Commercial |
$14,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,723.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,442.24
|
| Rate for Payer: Quartz Beloit One Network |
$8,757.28
|
| Rate for Payer: Quartz Commercial |
$10,723.20
|
| Rate for Payer: WEA Trust Commercial |
$9,829.60
|
| Rate for Payer: WPS Commercial |
$13,237.79
|
|
