|
REINFORCEMENT GORE SEAMGUARD ETHICON ENDO SURGERY EC60 12BSGEC60
|
Facility
|
IP
|
$2,199.00
|
|
| Hospital Charge Code |
5547400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.61 |
| Max. Negotiated Rate |
$2,104.00 |
| Rate for Payer: Aetna Commercial |
$2,058.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.09
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna Commercial |
$2,104.00
|
| Rate for Payer: Health EOS Commercial |
$2,035.39
|
| Rate for Payer: HFN Commercial |
$2,104.00
|
| Rate for Payer: Multiplan Commercial |
$1,829.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.61
|
| Rate for Payer: Quartz Commercial |
$1,372.18
|
| Rate for Payer: WEA Trust Commercial |
$1,257.83
|
| Rate for Payer: WPS Commercial |
$1,693.89
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON PROXIMATE 75 12OBSGPROX75
|
Facility
|
OP
|
$12,314.00
|
|
| Hospital Charge Code |
4640790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,585.84 |
| Max. Negotiated Rate |
$11,782.04 |
| Rate for Payer: Aetna Commercial |
$11,525.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,013.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,585.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,324.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,403.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,147.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,787.48
|
| Rate for Payer: Cash Price |
$3,694.20
|
| Rate for Payer: Cigna Commercial |
$11,782.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,166.75
|
| Rate for Payer: Health EOS Commercial |
$11,397.84
|
| Rate for Payer: HFN Commercial |
$11,782.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,604.92
|
| Rate for Payer: Multiplan Commercial |
$10,245.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,683.94
|
| Rate for Payer: Preferred Network Access Commercial |
$11,782.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,275.21
|
| Rate for Payer: Quartz Commercial |
$8,324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$7,683.94
|
| Rate for Payer: The Alliance Commercial |
$6,403.28
|
| Rate for Payer: WEA Trust Commercial |
$7,043.61
|
| Rate for Payer: WPS Commercial |
$9,485.47
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON PROXIMATE 75 12OBSGPROX75
|
Facility
|
IP
|
$12,314.00
|
|
| Hospital Charge Code |
4640790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,275.21 |
| Max. Negotiated Rate |
$11,782.04 |
| Rate for Payer: Aetna Commercial |
$11,525.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,013.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,787.48
|
| Rate for Payer: Cash Price |
$3,694.20
|
| Rate for Payer: Cigna Commercial |
$11,782.04
|
| Rate for Payer: Health EOS Commercial |
$11,397.84
|
| Rate for Payer: HFN Commercial |
$11,782.04
|
| Rate for Payer: Multiplan Commercial |
$10,245.25
|
| Rate for Payer: Preferred Network Access Commercial |
$11,782.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,275.21
|
| Rate for Payer: Quartz Commercial |
$7,683.94
|
| Rate for Payer: WEA Trust Commercial |
$7,043.61
|
| Rate for Payer: WPS Commercial |
$9,485.47
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| 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 |
$6,807.99
|
| 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
|
|
|
RELEASE OF BIG TOE 28240
|
Professional
|
Both
|
$1,310.00
|
|
|
Service Code
|
CPT 28240
|
| Hospital Charge Code |
3014224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,294.28 |
| Rate for Payer: Aetna Commercial |
$1,294.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,171.66
|
| Rate for Payer: Aetna Managed Medicare |
$272.31
|
| Rate for Payer: Anthem Medicare Advantage |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.31
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$1,294.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.31
|
| Rate for Payer: Health EOS Commercial |
$1,239.78
|
| Rate for Payer: HFN Commercial |
$1,294.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,032.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.31
|
| Rate for Payer: Multiplan Commercial |
$1,089.92
|
| Rate for Payer: NAPHCARE Commercial |
$408.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.28
|
| Rate for Payer: Quartz Beloit One Network |
$599.46
|
| Rate for Payer: Quartz Commercial |
$776.57
|
| Rate for Payer: Quartz Medicare Advantage |
$272.31
|
| Rate for Payer: The Alliance Commercial |
$1,157.33
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.31
|
| Rate for Payer: WEA Trust Commercial |
$749.32
|
| Rate for Payer: WPS Commercial |
$1,225.41
|
|
|
RELEASE OF FOOT CONTRACTURE 28270
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
3014226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$312.53 |
| Max. Negotiated Rate |
$1,406.39 |
| Rate for Payer: Aetna Commercial |
$1,131.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.09
|
| Rate for Payer: Aetna Managed Medicare |
$312.53
|
| Rate for Payer: Anthem Medicare Advantage |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$312.53
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$1,131.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$559.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.53
|
| Rate for Payer: Health EOS Commercial |
$1,083.63
|
| Rate for Payer: HFN Commercial |
$1,131.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,173.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$312.53
|
| Rate for Payer: Multiplan Commercial |
$952.64
|
| Rate for Payer: NAPHCARE Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.26
|
| Rate for Payer: Quartz Beloit One Network |
$523.95
|
| Rate for Payer: Quartz Commercial |
$678.76
|
| Rate for Payer: Quartz Medicare Advantage |
$312.53
|
| Rate for Payer: The Alliance Commercial |
$1,328.25
|
| Rate for Payer: United Healthcare Medicaid |
$559.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.53
|
| Rate for Payer: WEA Trust Commercial |
$654.94
|
| Rate for Payer: WPS Commercial |
$1,406.39
|
|
|
RELEASE OF FOOT TENDON 28220
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
CPT 28220
|
| Hospital Charge Code |
3014218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.22 |
| Max. Negotiated Rate |
$1,835.70 |
| Rate for Payer: Aetna Commercial |
$1,835.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,661.80
|
| Rate for Payer: Aetna Managed Medicare |
$284.22
|
| Rate for Payer: Anthem Medicare Advantage |
$284.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$284.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$284.22
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$1,835.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.22
|
| Rate for Payer: Health EOS Commercial |
$1,758.41
|
| Rate for Payer: HFN Commercial |
$1,835.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,065.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,065.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$284.22
|
| Rate for Payer: Multiplan Commercial |
$1,545.86
|
| Rate for Payer: NAPHCARE Commercial |
$426.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.70
|
| Rate for Payer: Quartz Beloit One Network |
$850.22
|
| Rate for Payer: Quartz Commercial |
$1,101.42
|
| Rate for Payer: Quartz Medicare Advantage |
$284.22
|
| Rate for Payer: The Alliance Commercial |
$1,207.94
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.22
|
| Rate for Payer: WEA Trust Commercial |
$1,062.78
|
| Rate for Payer: WPS Commercial |
$1,279.00
|
|
|
RELEASE OF FOOT TENDON 28225
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 28225
|
| Hospital Charge Code |
3014219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$1,406.91 |
| Rate for Payer: Aetna Commercial |
$1,406.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$246.82
|
| Rate for Payer: Anthem Medicare Advantage |
$246.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.82
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,406.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.82
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,406.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$927.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.82
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$370.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.91
|
| Rate for Payer: Quartz Beloit One Network |
$651.62
|
| Rate for Payer: Quartz Commercial |
$844.15
|
| Rate for Payer: Quartz Medicare Advantage |
$246.82
|
| Rate for Payer: The Alliance Commercial |
$1,049.00
|
| Rate for Payer: United Healthcare Medicaid |
$114.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.82
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,110.70
|
|
|
RELEASE OF TOE JOINT, EACH 28272
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
CPT 28272
|
| Hospital Charge Code |
3014227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.28 |
| Max. Negotiated Rate |
$1,063.25 |
| Rate for Payer: Aetna Commercial |
$938.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$236.28
|
| Rate for Payer: Anthem Medicare Advantage |
$236.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$236.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$236.28
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$938.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.28
|
| Rate for Payer: Health EOS Commercial |
$899.08
|
| Rate for Payer: HFN Commercial |
$938.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$884.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$884.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$236.28
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$354.42
|
| Rate for Payer: Preferred Network Access Commercial |
$938.60
|
| Rate for Payer: Quartz Beloit One Network |
$434.72
|
| Rate for Payer: Quartz Commercial |
$563.16
|
| Rate for Payer: Quartz Medicare Advantage |
$236.28
|
| Rate for Payer: The Alliance Commercial |
$1,004.18
|
| Rate for Payer: United Healthcare Medicaid |
$244.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.28
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$1,063.25
|
|
|
Release Palm Contracture 26040
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
CPT 26040
|
| Hospital Charge Code |
4590637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,967.11 |
| Rate for Payer: Aetna Commercial |
$1,967.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.75
|
| Rate for Payer: Aetna Managed Medicare |
$298.41
|
| Rate for Payer: Anthem Medicare Advantage |
$298.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$298.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$298.41
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cash Price |
$597.30
|
| Rate for Payer: Cigna Commercial |
$1,967.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.41
|
| Rate for Payer: Health EOS Commercial |
$1,884.28
|
| Rate for Payer: HFN Commercial |
$1,967.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,102.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,102.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$298.41
|
| Rate for Payer: Multiplan Commercial |
$1,656.51
|
| Rate for Payer: NAPHCARE Commercial |
$447.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.11
|
| Rate for Payer: Quartz Beloit One Network |
$911.08
|
| Rate for Payer: Quartz Commercial |
$1,180.26
|
| Rate for Payer: Quartz Medicare Advantage |
$298.41
|
| Rate for Payer: The Alliance Commercial |
$1,268.23
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.41
|
| Rate for Payer: WEA Trust Commercial |
$1,138.85
|
| Rate for Payer: WPS Commercial |
$1,342.83
|
|
|
Release Palm Contracture 2604050
|
Professional
|
Both
|
$3,755.00
|
|
|
Service Code
|
CPT 26040 50
|
| Hospital Charge Code |
5442684
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$3,709.94 |
| Rate for Payer: Aetna Commercial |
$3,709.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,358.47
|
| Rate for Payer: Cash Price |
$1,126.50
|
| Rate for Payer: Cash Price |
$1,126.50
|
| Rate for Payer: Cash Price |
$1,126.50
|
| Rate for Payer: Cigna Commercial |
$3,709.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,343.12
|
| Rate for Payer: Health EOS Commercial |
$3,553.73
|
| Rate for Payer: HFN Commercial |
$3,709.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,102.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,102.65
|
| Rate for Payer: Multiplan Commercial |
$3,124.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,709.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,718.29
|
| Rate for Payer: Quartz Commercial |
$2,225.96
|
| Rate for Payer: The Alliance Commercial |
$1,952.60
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: WEA Trust Commercial |
$2,147.86
|
| Rate for Payer: WPS Commercial |
$2,892.48
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
RELOAD #0 POLYSORB ENDO STITCH 48 VIOLET 170052"
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
5382987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.56 |
| Max. Negotiated Rate |
$952.97 |
| Rate for Payer: Aetna Commercial |
$932.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.00
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$952.97
|
| Rate for Payer: Health EOS Commercial |
$921.90
|
| Rate for Payer: HFN Commercial |
$952.97
|
| Rate for Payer: Multiplan Commercial |
$828.67
|
| Rate for Payer: Preferred Network Access Commercial |
$952.97
|
| Rate for Payer: Quartz Beloit One Network |
$507.56
|
| Rate for Payer: Quartz Commercial |
$621.50
|
| Rate for Payer: WEA Trust Commercial |
$569.71
|
| Rate for Payer: WPS Commercial |
$767.22
|
|
|
RELOAD #0 POLYSORB ENDO STITCH 48 VIOLET 170052"
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
5382987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.04 |
| Max. Negotiated Rate |
$952.97 |
| Rate for Payer: Aetna Commercial |
$932.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.82
|
| Rate for Payer: Aetna Managed Medicare |
$290.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$673.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$497.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.00
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$952.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$579.67
|
| Rate for Payer: Health EOS Commercial |
$921.90
|
| Rate for Payer: HFN Commercial |
$952.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$776.88
|
| Rate for Payer: Multiplan Commercial |
$828.67
|
| Rate for Payer: NAPHCARE Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$952.97
|
| Rate for Payer: Quartz Beloit One Network |
$507.56
|
| Rate for Payer: Quartz Commercial |
$673.30
|
| Rate for Payer: Quartz Medicare Advantage |
$621.50
|
| Rate for Payer: The Alliance Commercial |
$517.92
|
| Rate for Payer: WEA Trust Commercial |
$569.71
|
| Rate for Payer: WPS Commercial |
$767.22
|
|
|
RELOAD #0 SUSRGIDAC ENDO STITCH 48 GRN 173024"
|
Facility
|
OP
|
$1,259.00
|
|
| Hospital Charge Code |
2965508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.62 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Aetna Managed Medicare |
$366.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$851.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.74
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$982.02
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: NAPHCARE Commercial |
$785.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$851.08
|
| Rate for Payer: Quartz Medicare Advantage |
$785.62
|
| Rate for Payer: The Alliance Commercial |
$654.68
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
RELOAD #0 SUSRGIDAC ENDO STITCH 48 GRN 173024"
|
Facility
|
IP
|
$1,259.00
|
|
| Hospital Charge Code |
2965508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.59 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$785.62
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
RELOAD 2-0 POLYSORB ENDO STITCH 48 VIOLET 170053"
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
5382988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.04 |
| Max. Negotiated Rate |
$952.97 |
| Rate for Payer: Aetna Commercial |
$932.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.82
|
| Rate for Payer: Aetna Managed Medicare |
$290.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$673.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$497.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.00
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$952.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$579.67
|
| Rate for Payer: Health EOS Commercial |
$921.90
|
| Rate for Payer: HFN Commercial |
$952.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$776.88
|
| Rate for Payer: Multiplan Commercial |
$828.67
|
| Rate for Payer: NAPHCARE Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$952.97
|
| Rate for Payer: Quartz Beloit One Network |
$507.56
|
| Rate for Payer: Quartz Commercial |
$673.30
|
| Rate for Payer: Quartz Medicare Advantage |
$621.50
|
| Rate for Payer: The Alliance Commercial |
$517.92
|
| Rate for Payer: WEA Trust Commercial |
$569.71
|
| Rate for Payer: WPS Commercial |
$767.22
|
|
|
RELOAD 2-0 POLYSORB ENDO STITCH 48 VIOLET 170053"
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
5382988
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.56 |
| Max. Negotiated Rate |
$952.97 |
| Rate for Payer: Aetna Commercial |
$932.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$549.00
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$952.97
|
| Rate for Payer: Health EOS Commercial |
$921.90
|
| Rate for Payer: HFN Commercial |
$952.97
|
| Rate for Payer: Multiplan Commercial |
$828.67
|
| Rate for Payer: Preferred Network Access Commercial |
$952.97
|
| Rate for Payer: Quartz Beloit One Network |
$507.56
|
| Rate for Payer: Quartz Commercial |
$621.50
|
| Rate for Payer: WEA Trust Commercial |
$569.71
|
| Rate for Payer: WPS Commercial |
$767.22
|
|
|
RELOAD 2-0 SURGIDAC ENDO STITCH 48 GRN 173023"
|
Facility
|
IP
|
$1,259.00
|
|
| Hospital Charge Code |
2965509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.59 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$785.62
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
RELOAD 2-0 SURGIDAC ENDO STITCH 48 GRN 173023"
|
Facility
|
OP
|
$1,259.00
|
|
| Hospital Charge Code |
2965509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.62 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Aetna Managed Medicare |
$366.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$851.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.74
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$982.02
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: NAPHCARE Commercial |
$785.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$851.08
|
| Rate for Payer: Quartz Medicare Advantage |
$785.62
|
| Rate for Payer: The Alliance Commercial |
$654.68
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
RELOAD RELIATACK 5 DEEP RELTACK5RDPTSW
|
Facility
|
OP
|
$1,756.00
|
|
| Hospital Charge Code |
4640928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.35 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$511.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$876.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.99
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,369.68
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,187.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,095.74
|
| Rate for Payer: The Alliance Commercial |
$913.12
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
RELOAD RELIATACK 5 DEEP RELTACK5RDPTSW
|
Facility
|
IP
|
$1,756.00
|
|
| Hospital Charge Code |
4640928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,095.74
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
RELOAD RELIATACK 8 DEEP RELTACK8RDPTSW
|
Facility
|
IP
|
$2,392.00
|
|
| Hospital Charge Code |
4640733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.96 |
| Max. Negotiated Rate |
$2,288.67 |
| Rate for Payer: Aetna Commercial |
$2,238.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.47
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,288.67
|
| Rate for Payer: Health EOS Commercial |
$2,214.04
|
| Rate for Payer: HFN Commercial |
$2,288.67
|
| Rate for Payer: Multiplan Commercial |
$1,990.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,218.96
|
| Rate for Payer: Quartz Commercial |
$1,492.61
|
| Rate for Payer: WEA Trust Commercial |
$1,368.22
|
| Rate for Payer: WPS Commercial |
$1,842.56
|
|
|
RELOAD RELIATACK 8 DEEP RELTACK8RDPTSW
|
Facility
|
OP
|
$2,392.00
|
|
| Hospital Charge Code |
4640733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.55 |
| Max. Negotiated Rate |
$2,288.67 |
| Rate for Payer: Aetna Commercial |
$2,238.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.40
|
| Rate for Payer: Aetna Managed Medicare |
$696.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,616.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,243.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,194.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,318.47
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,288.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$2,214.04
|
| Rate for Payer: HFN Commercial |
$2,288.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,865.76
|
| Rate for Payer: Multiplan Commercial |
$1,990.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,492.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,218.96
|
| Rate for Payer: Quartz Commercial |
$1,616.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,492.61
|
| Rate for Payer: The Alliance Commercial |
$1,243.84
|
| Rate for Payer: WEA Trust Commercial |
$1,368.22
|
| Rate for Payer: WPS Commercial |
$1,842.56
|
|
|
Rem endovas vena cava filter 37193
|
Professional
|
Both
|
$7,139.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3014545
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$286.77 |
| Max. Negotiated Rate |
$7,053.33 |
| Rate for Payer: Aetna Commercial |
$7,053.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,385.12
|
| Rate for Payer: Aetna Managed Medicare |
$286.77
|
| Rate for Payer: Anthem Medicare Advantage |
$286.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$286.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$286.77
|
| Rate for Payer: Cash Price |
$2,141.70
|
| Rate for Payer: Cash Price |
$2,141.70
|
| Rate for Payer: Cash Price |
$2,141.70
|
| Rate for Payer: Cigna Commercial |
$7,053.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,356.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.77
|
| Rate for Payer: Health EOS Commercial |
$6,756.35
|
| Rate for Payer: HFN Commercial |
$7,053.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,188.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$286.77
|
| Rate for Payer: Multiplan Commercial |
$5,939.65
|
| Rate for Payer: NAPHCARE Commercial |
$430.15
|
| Rate for Payer: Preferred Network Access Commercial |
$7,053.33
|
| Rate for Payer: Quartz Beloit One Network |
$3,266.81
|
| Rate for Payer: Quartz Commercial |
$4,232.00
|
| Rate for Payer: Quartz Medicare Advantage |
$286.77
|
| Rate for Payer: The Alliance Commercial |
$1,218.77
|
| Rate for Payer: United Healthcare Medicaid |
$1,356.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$286.77
|
| Rate for Payer: WEA Trust Commercial |
$4,083.51
|
| Rate for Payer: WPS Commercial |
$1,290.46
|
|
