|
STRYKER REUNION REVERSE TOTAL SHOULDER IMPLANTS (INCLUDES: GLENOSPHERE,GLENOID BASEPLATE, HUMERAL ST
|
Facility
|
OP
|
$41,801.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,172.45 |
| Max. Negotiated Rate |
$39,995.20 |
| Rate for Payer: Aetna Commercial |
$39,125.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,386.81
|
| Rate for Payer: Aetna Managed Medicare |
$12,172.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,257.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,736.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,867.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,040.71
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$39,995.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,328.18
|
| Rate for Payer: Health EOS Commercial |
$38,691.01
|
| Rate for Payer: HFN Commercial |
$39,995.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,604.78
|
| Rate for Payer: Multiplan Commercial |
$34,778.43
|
| Rate for Payer: NAPHCARE Commercial |
$26,083.82
|
| Rate for Payer: Preferred Network Access Commercial |
$39,995.20
|
| Rate for Payer: Quartz Beloit One Network |
$21,301.79
|
| Rate for Payer: Quartz Commercial |
$28,257.48
|
| Rate for Payer: Quartz Medicare Advantage |
$26,083.82
|
| Rate for Payer: The Alliance Commercial |
$21,736.52
|
| Rate for Payer: WEA Trust Commercial |
$23,910.17
|
| Rate for Payer: WPS Commercial |
$32,199.31
|
|
|
STRYKER REUNION REVERSE TOTAL SHOULDER IMPLANTS (INCLUDES: GLENOSPHERE,GLENOID BASEPLATE, HUMERAL ST
|
Facility
|
IP
|
$41,801.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5803729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,301.79 |
| Max. Negotiated Rate |
$39,995.20 |
| Rate for Payer: Aetna Commercial |
$39,125.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,386.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,040.71
|
| Rate for Payer: Cash Price |
$12,540.30
|
| Rate for Payer: Cigna Commercial |
$39,995.20
|
| Rate for Payer: Health EOS Commercial |
$38,691.01
|
| Rate for Payer: HFN Commercial |
$39,995.20
|
| Rate for Payer: Multiplan Commercial |
$34,778.43
|
| Rate for Payer: Preferred Network Access Commercial |
$39,995.20
|
| Rate for Payer: Quartz Beloit One Network |
$21,301.79
|
| Rate for Payer: Quartz Commercial |
$26,083.82
|
| Rate for Payer: WEA Trust Commercial |
$23,910.17
|
| Rate for Payer: WPS Commercial |
$32,199.31
|
|
|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
IP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,343.82 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,645.49
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
STYLET FALLER TUNNELLING 8888415679
|
Facility
|
OP
|
$2,637.00
|
|
| Hospital Charge Code |
4520283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$767.89 |
| Max. Negotiated Rate |
$2,523.08 |
| Rate for Payer: Aetna Commercial |
$2,468.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,358.53
|
| Rate for Payer: Aetna Managed Medicare |
$767.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,782.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,371.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,316.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,453.51
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna Commercial |
$2,523.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,534.73
|
| Rate for Payer: Health EOS Commercial |
$2,440.81
|
| Rate for Payer: HFN Commercial |
$2,523.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,056.86
|
| Rate for Payer: Multiplan Commercial |
$2,193.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,645.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,523.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.82
|
| Rate for Payer: Quartz Commercial |
$1,782.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,645.49
|
| Rate for Payer: The Alliance Commercial |
$1,371.24
|
| Rate for Payer: WEA Trust Commercial |
$1,508.36
|
| Rate for Payer: WPS Commercial |
$2,031.28
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
STYLET INTUBATING SZ 5.0-10MM #85865
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2974644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
STYLET SATIN SLIP-ADULT 10FR 5-15101
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
2963533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
STYLET SATIN SLIP -PEDS 6FR DYND43506***DEDE 10/23
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
2963540
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
STYLET SPRING WIRE GUIDE
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2962948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
SUBACROMIAL DECOMPRESSION
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
Subconjunctival Injection
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
1188934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$28.75
|
| Rate for Payer: Anthem Medicare Advantage |
$28.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.75
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$311.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.75
|
| Rate for Payer: Health EOS Commercial |
$298.12
|
| Rate for Payer: HFN Commercial |
$311.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$43.12
|
| Rate for Payer: Preferred Network Access Commercial |
$311.22
|
| Rate for Payer: Quartz Beloit One Network |
$144.14
|
| Rate for Payer: Quartz Commercial |
$186.73
|
| Rate for Payer: Quartz Medicare Advantage |
$28.75
|
| Rate for Payer: The Alliance Commercial |
$122.17
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.75
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$129.36
|
|
|
Subconjunctival Injenction 6820050
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
CPT 68200 50
|
| Hospital Charge Code |
5438754
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$585.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.38
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$585.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$370.03
|
| Rate for Payer: Health EOS Commercial |
$561.22
|
| Rate for Payer: HFN Commercial |
$585.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.79
|
| Rate for Payer: Multiplan Commercial |
$493.38
|
| Rate for Payer: Preferred Network Access Commercial |
$585.88
|
| Rate for Payer: Quartz Beloit One Network |
$271.36
|
| Rate for Payer: Quartz Commercial |
$351.53
|
| Rate for Payer: The Alliance Commercial |
$308.36
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: WEA Trust Commercial |
$339.20
|
| Rate for Payer: WPS Commercial |
$456.79
|
|
|
SUBFASCIAL ENDOSCOPIC PERFORATER SURGERY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960369
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
SUBFASCIAL ENDOSCOPIC PERFORATER SURGERY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960369
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
SUBMUCOSAL INJECTION
|
Facility
|
OP
|
$917.00
|
|
| Hospital Charge Code |
4253750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$267.03 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Aetna Managed Medicare |
$267.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.69
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.26
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: NAPHCARE Commercial |
$572.21
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$619.89
|
| Rate for Payer: Quartz Medicare Advantage |
$572.21
|
| Rate for Payer: The Alliance Commercial |
$476.84
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
SUBMUCOSAL INJECTION
|
Facility
|
IP
|
$917.00
|
|
| Hospital Charge Code |
4253750
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$467.30 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$572.21
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
Submucous resection inferior turbinate, partial or complete, any method
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| 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 |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
Subsequent - Chest Physiotherapy Charge
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
2990158
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Subsequent - Chest Physiotherapy Charge
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
2990158
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Subsequent - Handheld Nebulizer Charge
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990156
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.96
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Subsequent - Handheld Nebulizer Charge
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990156
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
