|
SLING ENVELOPE ARM MED 8001-03
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
2974241
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
SLING LARGE 190-320LB #50312
|
Facility
|
OP
|
$2,550.00
|
|
| Hospital Charge Code |
2970185
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$742.56 |
| Max. Negotiated Rate |
$2,439.84 |
| Rate for Payer: Aetna Commercial |
$2,386.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,280.72
|
| Rate for Payer: Aetna Managed Medicare |
$742.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,723.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,326.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,272.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,405.56
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$2,439.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,484.10
|
| Rate for Payer: Health EOS Commercial |
$2,360.28
|
| Rate for Payer: HFN Commercial |
$2,439.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,989.00
|
| Rate for Payer: Multiplan Commercial |
$2,121.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,439.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.48
|
| Rate for Payer: Quartz Commercial |
$1,723.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,591.20
|
| Rate for Payer: The Alliance Commercial |
$1,326.00
|
| Rate for Payer: WEA Trust Commercial |
$1,458.60
|
| Rate for Payer: WPS Commercial |
$1,964.27
|
|
|
SLING LARGE 190-320LB #50312
|
Facility
|
IP
|
$2,550.00
|
|
| Hospital Charge Code |
2970185
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,299.48 |
| Max. Negotiated Rate |
$2,439.84 |
| Rate for Payer: Aetna Commercial |
$2,386.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,280.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,405.56
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$2,439.84
|
| Rate for Payer: Health EOS Commercial |
$2,360.28
|
| Rate for Payer: HFN Commercial |
$2,439.84
|
| Rate for Payer: Multiplan Commercial |
$2,121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,439.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.48
|
| Rate for Payer: Quartz Commercial |
$1,591.20
|
| Rate for Payer: WEA Trust Commercial |
$1,458.60
|
| Rate for Payer: WPS Commercial |
$1,964.27
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
Slings A4565
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
3133607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$11.42
|
| Rate for Payer: Anthem Medicare Advantage |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.42
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.42
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.42
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11.42
|
| Rate for Payer: The Alliance Commercial |
$31.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.42
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$19.98
|
|
|
Slings A4565
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
3133607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Slings A4565
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
3133607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$45.68
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
SLING STRAP ARM LARGE W/ PAD 8006-04
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2964021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
SLING STRAP ARM LARGE W/ PAD 8006-04
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2964021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
SLING STRAP ARM w/PAD SMALL 8006-02
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2964022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
SLING STRAP ARM w/PAD SMALL 8006-02
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2964022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
SLING XL 280-450 LB #50313
|
Facility
|
IP
|
$3,038.00
|
|
| Hospital Charge Code |
2970186
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,548.16 |
| Max. Negotiated Rate |
$2,906.76 |
| Rate for Payer: Aetna Commercial |
$2,843.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,717.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,674.55
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$2,906.76
|
| Rate for Payer: Health EOS Commercial |
$2,811.97
|
| Rate for Payer: HFN Commercial |
$2,906.76
|
| Rate for Payer: Multiplan Commercial |
$2,527.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,906.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.16
|
| Rate for Payer: Quartz Commercial |
$1,895.71
|
| Rate for Payer: WEA Trust Commercial |
$1,737.74
|
| Rate for Payer: WPS Commercial |
$2,340.17
|
|
|
SLING XL 280-450 LB #50313
|
Facility
|
OP
|
$3,038.00
|
|
| Hospital Charge Code |
2970186
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$884.67 |
| Max. Negotiated Rate |
$2,906.76 |
| Rate for Payer: Aetna Commercial |
$2,843.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,717.19
|
| Rate for Payer: Aetna Managed Medicare |
$884.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,053.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,579.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,516.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,674.55
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: Cigna Commercial |
$2,906.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,768.12
|
| Rate for Payer: Health EOS Commercial |
$2,811.97
|
| Rate for Payer: HFN Commercial |
$2,906.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,369.64
|
| Rate for Payer: Multiplan Commercial |
$2,527.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,895.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,906.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.16
|
| Rate for Payer: Quartz Commercial |
$2,053.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,895.71
|
| Rate for Payer: The Alliance Commercial |
$1,579.76
|
| Rate for Payer: WEA Trust Commercial |
$1,737.74
|
| Rate for Payer: WPS Commercial |
$2,340.17
|
|
|
SLIT KNIFE SINGLE BEVEL 2.4MM 8065992445
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
5415573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
SLIT KNIFE SINGLE BEVEL 2.4MM 8065992445
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
5415573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
SLITTING OF PREPUCE 54001
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
3015017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$567.92 |
| Rate for Payer: Aetna Commercial |
$470.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Aetna Managed Medicare |
$126.20
|
| Rate for Payer: Anthem Medicare Advantage |
$126.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.20
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$470.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.20
|
| Rate for Payer: Health EOS Commercial |
$450.49
|
| Rate for Payer: HFN Commercial |
$470.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.20
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: NAPHCARE Commercial |
$189.31
|
| Rate for Payer: Preferred Network Access Commercial |
$470.29
|
| Rate for Payer: Quartz Beloit One Network |
$217.82
|
| Rate for Payer: Quartz Commercial |
$282.17
|
| Rate for Payer: Quartz Medicare Advantage |
$126.20
|
| Rate for Payer: The Alliance Commercial |
$536.37
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.20
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$567.92
|
|
|
SLOTTED PLATE HOFFMAN LIMB 4934-1-060
|
Facility
|
OP
|
$1,583.00
|
|
| Hospital Charge Code |
6001646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.97 |
| Max. Negotiated Rate |
$1,514.61 |
| Rate for Payer: Aetna Commercial |
$1,481.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,415.84
|
| Rate for Payer: Aetna Managed Medicare |
$460.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.55
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,514.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.31
|
| Rate for Payer: Health EOS Commercial |
$1,465.22
|
| Rate for Payer: HFN Commercial |
$1,514.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,234.74
|
| Rate for Payer: Multiplan Commercial |
$1,317.06
|
| Rate for Payer: NAPHCARE Commercial |
$987.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.61
|
| Rate for Payer: Quartz Beloit One Network |
$806.70
|
| Rate for Payer: Quartz Commercial |
$1,070.11
|
| Rate for Payer: Quartz Medicare Advantage |
$987.79
|
| Rate for Payer: The Alliance Commercial |
$823.16
|
| Rate for Payer: WEA Trust Commercial |
$905.48
|
| Rate for Payer: WPS Commercial |
$1,219.38
|
|
|
SLOTTED PLATE HOFFMAN LIMB 4934-1-060
|
Facility
|
IP
|
$1,583.00
|
|
| Hospital Charge Code |
6001646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$806.70 |
| Max. Negotiated Rate |
$1,514.61 |
| Rate for Payer: Aetna Commercial |
$1,481.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,415.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.55
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,514.61
|
| Rate for Payer: Health EOS Commercial |
$1,465.22
|
| Rate for Payer: HFN Commercial |
$1,514.61
|
| Rate for Payer: Multiplan Commercial |
$1,317.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.61
|
| Rate for Payer: Quartz Beloit One Network |
$806.70
|
| Rate for Payer: Quartz Commercial |
$987.79
|
| Rate for Payer: WEA Trust Commercial |
$905.48
|
| Rate for Payer: WPS Commercial |
$1,219.38
|
|
|
SLP Cognitive Function Intervention Chrg
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
5344656
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$133.54
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$133.54
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
SLP Cognitive Function Intervention Chrg
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
5344656
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Facility
|
IP
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$7,615.46 |
| Max. Negotiated Rate |
$14,298.42 |
| Rate for Payer: Aetna Commercial |
$13,987.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,237.13
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,298.42
|
| Rate for Payer: Health EOS Commercial |
$13,832.17
|
| Rate for Payer: HFN Commercial |
$14,298.42
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: Preferred Network Access Commercial |
$14,298.42
|
| Rate for Payer: Quartz Beloit One Network |
$7,615.46
|
| Rate for Payer: Quartz Commercial |
$9,325.06
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Facility
|
OP
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3,286.19 |
| Max. Negotiated Rate |
$14,298.42 |
| Rate for Payer: Aetna Commercial |
$13,987.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Aetna Managed Medicare |
$3,286.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,102.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,770.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,460.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,286.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,237.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,286.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,286.19
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,298.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,286.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,697.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,286.19
|
| Rate for Payer: Health EOS Commercial |
$13,832.17
|
| Rate for Payer: HFN Commercial |
$14,298.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,224.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,286.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,286.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,286.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,286.19
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.29
|
| Rate for Payer: Preferred Network Access Commercial |
$14,298.42
|
| Rate for Payer: Quartz Beloit One Network |
$7,615.46
|
| Rate for Payer: Quartz Commercial |
$10,102.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,286.19
|
| Rate for Payer: The Alliance Commercial |
$13,144.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,286.19
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: Wellcare Medicare |
$3,286.19
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Professional
|
Both
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$6,838.37 |
| Max. Negotiated Rate |
$29,668.71 |
| Rate for Payer: Aetna Commercial |
$14,764.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,764.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,770.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,325.06
|
| Rate for Payer: Health EOS Commercial |
$14,143.00
|
| Rate for Payer: HFN Commercial |
$14,764.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,668.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,668.71
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: Preferred Network Access Commercial |
$14,764.67
|
| Rate for Payer: Quartz Beloit One Network |
$6,838.37
|
| Rate for Payer: Quartz Commercial |
$8,858.80
|
| Rate for Payer: The Alliance Commercial |
$7,770.88
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
SMA Carrier Screen
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
3805565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$914.63
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$1,055.34
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
SMA Carrier Screen
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
3805565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$689.49 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$844.27
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
