|
REPAIR, SECONDARY, DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG, WATSON-JONES PROCEDURE)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27698
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,947.89 |
| 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 |
$4,947.89
|
| 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
|
|
|
Repair Superficial Wounds (S) 12001
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3713510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$484.12 |
| Rate for Payer: Aetna Commercial |
$484.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$41.06
|
| Rate for Payer: Anthem Medicare Advantage |
$41.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.06
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$484.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.06
|
| Rate for Payer: Health EOS Commercial |
$463.74
|
| Rate for Payer: HFN Commercial |
$484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.06
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$61.59
|
| Rate for Payer: Preferred Network Access Commercial |
$484.12
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$290.47
|
| Rate for Payer: Quartz Medicare Advantage |
$41.06
|
| Rate for Payer: The Alliance Commercial |
$174.50
|
| Rate for Payer: United Healthcare Medicaid |
$53.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.06
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$184.77
|
|
|
Repair Superficial Wounds (S) 3779912001
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
5453139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna Commercial |
$456.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$456.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.29
|
| Rate for Payer: Health EOS Commercial |
$437.24
|
| Rate for Payer: HFN Commercial |
$456.46
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$456.46
|
| Rate for Payer: Quartz Beloit One Network |
$211.41
|
| Rate for Payer: Quartz Commercial |
$273.87
|
| Rate for Payer: The Alliance Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
IP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,626.84 |
| Max. Negotiated Rate |
$12,442.23 |
| Rate for Payer: Aetna Commercial |
$12,171.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,630.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,167.80
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$12,442.23
|
| Rate for Payer: Health EOS Commercial |
$12,036.50
|
| Rate for Payer: HFN Commercial |
$12,442.23
|
| Rate for Payer: Multiplan Commercial |
$10,819.33
|
| Rate for Payer: Preferred Network Access Commercial |
$12,442.23
|
| Rate for Payer: Quartz Beloit One Network |
$6,626.84
|
| Rate for Payer: Quartz Commercial |
$8,114.50
|
| Rate for Payer: WEA Trust Commercial |
$7,438.29
|
| Rate for Payer: WPS Commercial |
$10,016.98
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
OP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,786.76 |
| Max. Negotiated Rate |
$12,442.23 |
| Rate for Payer: Aetna Commercial |
$12,171.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,630.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,786.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,790.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,762.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,491.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,167.80
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$12,442.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,568.33
|
| Rate for Payer: Health EOS Commercial |
$12,036.50
|
| Rate for Payer: HFN Commercial |
$12,442.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,143.12
|
| Rate for Payer: Multiplan Commercial |
$10,819.33
|
| Rate for Payer: NAPHCARE Commercial |
$8,114.50
|
| Rate for Payer: Preferred Network Access Commercial |
$12,442.23
|
| Rate for Payer: Quartz Beloit One Network |
$6,626.84
|
| Rate for Payer: Quartz Commercial |
$8,790.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,114.50
|
| Rate for Payer: The Alliance Commercial |
$6,762.08
|
| Rate for Payer: WEA Trust Commercial |
$7,438.29
|
| Rate for Payer: WPS Commercial |
$10,016.98
|
|
|
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28200
|
|
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 |
$6,807.99
|
| 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
|
|
|
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25270
|
|
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 |
$8,107.14
|
| 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
|
|
|
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25260
|
|
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 |
$8,107.14
|
| 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
|
|
|
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACH TENDON OR MUSCLE, PRIMARY OR SECONDARY (EXCLUDES ROTATOR CUFF)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 24341
|
|
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
|
|
|
REPAIR TOE DISLOCATION 28645
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
CPT 28645
|
| Hospital Charge Code |
3014272
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,200.28 |
| Rate for Payer: Aetna Commercial |
$2,200.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Aetna Managed Medicare |
$449.82
|
| Rate for Payer: Anthem Medicare Advantage |
$449.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$449.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$449.82
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,200.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.82
|
| Rate for Payer: Health EOS Commercial |
$2,107.63
|
| Rate for Payer: HFN Commercial |
$2,200.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,700.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,700.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$449.82
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: NAPHCARE Commercial |
$674.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.08
|
| Rate for Payer: Quartz Commercial |
$1,320.17
|
| Rate for Payer: Quartz Medicare Advantage |
$449.82
|
| Rate for Payer: The Alliance Commercial |
$1,911.74
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$449.82
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$2,024.19
|
|
|
REPAIR TOE DISLOCATION 28675
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
3014275
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,731.93 |
| Rate for Payer: Aetna Commercial |
$1,082.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$980.26
|
| Rate for Payer: Aetna Managed Medicare |
$384.87
|
| Rate for Payer: Anthem Medicare Advantage |
$384.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$384.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$384.87
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$1,082.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.87
|
| Rate for Payer: Health EOS Commercial |
$1,037.25
|
| Rate for Payer: HFN Commercial |
$1,082.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,414.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$384.87
|
| Rate for Payer: Multiplan Commercial |
$911.87
|
| Rate for Payer: NAPHCARE Commercial |
$577.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,082.85
|
| Rate for Payer: Quartz Beloit One Network |
$501.53
|
| Rate for Payer: Quartz Commercial |
$649.71
|
| Rate for Payer: Quartz Medicare Advantage |
$384.87
|
| Rate for Payer: The Alliance Commercial |
$1,635.71
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.87
|
| Rate for Payer: WEA Trust Commercial |
$626.91
|
| Rate for Payer: WPS Commercial |
$1,731.93
|
|
|
REPAIR TONGUE LACERATION 41250
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
3014617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$496.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$159.36
|
| Rate for Payer: Anthem Medicare Advantage |
$159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.36
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$496.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.36
|
| Rate for Payer: Health EOS Commercial |
$476.04
|
| Rate for Payer: HFN Commercial |
$496.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$531.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.36
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$239.04
|
| Rate for Payer: Preferred Network Access Commercial |
$496.96
|
| Rate for Payer: Quartz Beloit One Network |
$230.17
|
| Rate for Payer: Quartz Commercial |
$298.18
|
| Rate for Payer: Quartz Medicare Advantage |
$159.36
|
| Rate for Payer: The Alliance Commercial |
$677.28
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.36
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$717.12
|
|
|
REPAIR TONGUE LACERATION 41252
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
3014618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.90 |
| Max. Negotiated Rate |
$945.52 |
| Rate for Payer: Aetna Commercial |
$945.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$855.94
|
| Rate for Payer: Aetna Managed Medicare |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.68
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna Commercial |
$945.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$905.70
|
| Rate for Payer: HFN Commercial |
$945.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$721.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$721.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$796.22
|
| Rate for Payer: NAPHCARE Commercial |
$281.52
|
| Rate for Payer: Preferred Network Access Commercial |
$945.52
|
| Rate for Payer: Quartz Beloit One Network |
$437.92
|
| Rate for Payer: Quartz Commercial |
$567.31
|
| Rate for Payer: Quartz Medicare Advantage |
$187.68
|
| Rate for Payer: The Alliance Commercial |
$797.63
|
| Rate for Payer: United Healthcare Medicaid |
$170.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.68
|
| Rate for Payer: WEA Trust Commercial |
$547.40
|
| Rate for Payer: WPS Commercial |
$844.55
|
|
|
REPAIR UPPER JAW FISTULA 30580
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
CPT 30580
|
| Hospital Charge Code |
3014361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$408.68 |
| Max. Negotiated Rate |
$2,942.26 |
| Rate for Payer: Aetna Commercial |
$2,942.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,663.52
|
| Rate for Payer: Aetna Managed Medicare |
$408.68
|
| Rate for Payer: Anthem Medicare Advantage |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$408.68
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cash Price |
$893.40
|
| Rate for Payer: Cigna Commercial |
$2,942.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$532.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.68
|
| Rate for Payer: Health EOS Commercial |
$2,818.38
|
| Rate for Payer: HFN Commercial |
$2,942.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$408.68
|
| Rate for Payer: Multiplan Commercial |
$2,477.70
|
| Rate for Payer: NAPHCARE Commercial |
$613.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,942.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,362.73
|
| Rate for Payer: Quartz Commercial |
$1,765.36
|
| Rate for Payer: Quartz Medicare Advantage |
$408.68
|
| Rate for Payer: The Alliance Commercial |
$1,736.88
|
| Rate for Payer: United Healthcare Medicaid |
$532.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.68
|
| Rate for Payer: WEA Trust Commercial |
$1,703.42
|
| Rate for Payer: WPS Commercial |
$1,839.05
|
|
|
REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS 49450
|
Professional
|
Both
|
$3,177.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
6187349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$3,138.88 |
| Rate for Payer: Aetna Commercial |
$3,138.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,841.51
|
| Rate for Payer: Aetna Managed Medicare |
$54.80
|
| Rate for Payer: Anthem Medicare Advantage |
$54.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.80
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cash Price |
$953.10
|
| Rate for Payer: Cigna Commercial |
$3,138.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$601.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.80
|
| Rate for Payer: Health EOS Commercial |
$3,006.71
|
| Rate for Payer: HFN Commercial |
$3,138.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$2,643.26
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,138.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,453.80
|
| Rate for Payer: Quartz Commercial |
$1,883.33
|
| Rate for Payer: Quartz Medicare Advantage |
$54.80
|
| Rate for Payer: The Alliance Commercial |
$232.89
|
| Rate for Payer: United Healthcare Medicaid |
$601.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.80
|
| Rate for Payer: WEA Trust Commercial |
$1,817.24
|
| Rate for Payer: WPS Commercial |
$246.59
|
|
|
REPLACE G-J TUBE PERC 49452
|
Professional
|
Both
|
$2,016.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
3014888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.77 |
| Max. Negotiated Rate |
$1,991.81 |
| Rate for Payer: Aetna Commercial |
$1,991.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,803.11
|
| Rate for Payer: Aetna Managed Medicare |
$113.77
|
| Rate for Payer: Anthem Medicare Advantage |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.77
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$1,991.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$780.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.77
|
| Rate for Payer: Health EOS Commercial |
$1,907.94
|
| Rate for Payer: HFN Commercial |
$1,991.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$479.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.77
|
| Rate for Payer: Multiplan Commercial |
$1,677.31
|
| Rate for Payer: NAPHCARE Commercial |
$170.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.81
|
| Rate for Payer: Quartz Beloit One Network |
$922.52
|
| Rate for Payer: Quartz Commercial |
$1,195.08
|
| Rate for Payer: Quartz Medicare Advantage |
$113.77
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$780.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.77
|
| Rate for Payer: WEA Trust Commercial |
$1,153.15
|
| Rate for Payer: WPS Commercial |
$511.95
|
|
|
REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36578
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| 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 |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
|
|
REPLACE TUNNELED CV CATH 36581
|
Professional
|
Both
|
$3,329.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3014535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.94 |
| Max. Negotiated Rate |
$3,289.05 |
| Rate for Payer: Aetna Commercial |
$3,289.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,977.46
|
| Rate for Payer: Aetna Managed Medicare |
$158.94
|
| Rate for Payer: Anthem Medicare Advantage |
$158.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.94
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cigna Commercial |
$3,289.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$638.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.94
|
| Rate for Payer: Health EOS Commercial |
$3,150.57
|
| Rate for Payer: HFN Commercial |
$3,289.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$636.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.94
|
| Rate for Payer: Multiplan Commercial |
$2,769.73
|
| Rate for Payer: NAPHCARE Commercial |
$238.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,289.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.35
|
| Rate for Payer: Quartz Commercial |
$1,973.43
|
| Rate for Payer: Quartz Medicare Advantage |
$158.94
|
| Rate for Payer: The Alliance Commercial |
$675.51
|
| Rate for Payer: United Healthcare Medicaid |
$638.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.94
|
| Rate for Payer: WEA Trust Commercial |
$1,904.19
|
| Rate for Payer: WPS Commercial |
$715.24
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,885.39 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$10,880.06
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$532.31 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,077.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,786.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,066.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,704.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,600.08
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$10,880.06
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$11,786.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,880.06
|
| Rate for Payer: The Alliance Commercial |
$532.31
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,714.93
|
|
|
Service Code
|
CPT 66825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.73 |
| Max. Negotiated Rate |
$9,714.93 |
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| 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 |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
|
|
RESECT INFERIOR TURBINATE 30140
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
3014355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$662.92 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$147.32
|
| Rate for Payer: Anthem Medicare Advantage |
$147.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.32
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.32
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.32
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$220.97
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| Rate for Payer: Quartz Medicare Advantage |
$147.32
|
| Rate for Payer: The Alliance Commercial |
$626.09
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.32
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$662.92
|
|
