|
ARTHRITIS MITT SPLINT #A309-6
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
HCPCS A4570
|
| Hospital Charge Code |
2971861
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$268.49 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Aetna Managed Medicare |
$268.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.60
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.16
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: NAPHCARE Commercial |
$575.33
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$623.27
|
| Rate for Payer: Quartz Medicare Advantage |
$575.33
|
| Rate for Payer: The Alliance Commercial |
$479.44
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
ARTHRITIS MITT SPLINT #A309-6
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
HCPCS A4570
|
| Hospital Charge Code |
2971861
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$469.85 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$575.33
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
Arthro, Aspir or Inj; Major Joint 20610
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5995639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$381.89
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Arthro, Aspir or Inj; Major Joint 20610
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
5995639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$305.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$413.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$318.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$305.51
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$413.71
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 20605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.03 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
|
|
Arthrocentesis, Aspiration and/or Injection; Major Joint or Bursa
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
1188962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$37.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.79
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.79
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.79
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$56.69
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$37.79
|
| Rate for Payer: The Alliance Commercial |
$160.62
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$170.07
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.03 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
|
|
Arthrocentesis, Aspiration and/or Injection; Medium Joint or Bursa
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
1188961
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$31.11
|
| Rate for Payer: Anthem Medicare Advantage |
$31.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.11
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.11
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.11
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$46.66
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$31.11
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare Medicaid |
$51.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.11
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$139.98
|
|
|
Arthrocentesis, Aspiration and/or Injection Small Joint or Bursa
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
1188960
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$136.84 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$30.41
|
| Rate for Payer: Anthem Medicare Advantage |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.41
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.41
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.41
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$45.61
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$30.41
|
| Rate for Payer: The Alliance Commercial |
$129.24
|
| Rate for Payer: United Healthcare Medicaid |
$40.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.41
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$136.84
|
|
|
Arthrocentesis, Aspiration and/or Inj; Medium Joint or Bursa 2060550
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 20605 50
|
| Hospital Charge Code |
5454744
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$349.75 |
| Rate for Payer: Aetna Commercial |
$349.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$349.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.90
|
| Rate for Payer: Health EOS Commercial |
$335.03
|
| Rate for Payer: HFN Commercial |
$349.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.16
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$349.75
|
| Rate for Payer: Quartz Beloit One Network |
$161.99
|
| Rate for Payer: Quartz Commercial |
$209.85
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: United Healthcare Medicaid |
$51.54
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
Arthrocentesis Aspir&/Inj Major 2061150
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
CPT 20611 50
|
| Hospital Charge Code |
5374812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Aetna Commercial |
$2,099.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.00
|
| Rate for Payer: Health EOS Commercial |
$2,011.10
|
| Rate for Payer: HFN Commercial |
$2,099.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.16
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,099.50
|
| Rate for Payer: Quartz Beloit One Network |
$972.40
|
| Rate for Payer: Quartz Commercial |
$1,259.70
|
| Rate for Payer: The Alliance Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare Medicaid |
$72.74
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.89
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 27870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 26850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 28730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT CORRECTION)
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 28735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 28740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 28725
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHRODESIS, WRIST; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 25810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,673.35 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHROEREISIS SUBTALAR 10mm
|
Facility
|
OP
|
$7,627.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.98 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Aetna Managed Medicare |
$2,220.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,155.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,966.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,807.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,438.91
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,949.06
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: NAPHCARE Commercial |
$4,759.25
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$5,155.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,759.25
|
| Rate for Payer: The Alliance Commercial |
$3,966.04
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
ARTHROEREISIS SUBTALAR 10mm
|
Facility
|
IP
|
$7,627.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.72 |
| Max. Negotiated Rate |
$7,297.51 |
| Rate for Payer: Aetna Commercial |
$7,138.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,821.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,204.00
|
| Rate for Payer: Cash Price |
$2,288.10
|
| Rate for Payer: Cigna Commercial |
$7,297.51
|
| Rate for Payer: Health EOS Commercial |
$7,059.55
|
| Rate for Payer: HFN Commercial |
$7,297.51
|
| Rate for Payer: Multiplan Commercial |
$6,345.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,297.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,886.72
|
| Rate for Payer: Quartz Commercial |
$4,759.25
|
| Rate for Payer: WEA Trust Commercial |
$4,362.64
|
| Rate for Payer: WPS Commercial |
$5,875.08
|
|
|
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 27130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,790.08 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERAL PROSTHETIC REPLACEMENT
|
Facility
|
OP
|
$73,809.59
|
|
|
Service Code
|
CPT 24361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,673.35 |
| Max. Negotiated Rate |
$73,809.59 |
| Rate for Payer: Aetna Managed Medicare |
$18,452.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,452.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,452.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,452.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,642.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,452.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,452.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,452.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,452.40
|
| Rate for Payer: NAPHCARE Commercial |
$27,678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18,452.40
|
| Rate for Payer: The Alliance Commercial |
$73,809.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,452.40
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: Wellcare Medicare |
$18,452.40
|
|
|
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))
|
Facility
|
OP
|
$73,809.59
|
|
|
Service Code
|
CPT 23472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,790.08 |
| Max. Negotiated Rate |
$73,809.59 |
| Rate for Payer: Aetna Managed Medicare |
$18,452.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,452.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,452.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,452.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,642.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,452.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,452.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,452.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,452.40
|
| Rate for Payer: NAPHCARE Commercial |
$27,678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18,452.40
|
| Rate for Payer: The Alliance Commercial |
$73,809.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,452.40
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$18,452.40
|
|
|
ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
