|
Temperature Probe Indwelling/Continuous - Urinary Catheter Type
|
Facility
OP
|
$664.00
|
|
| Hospital Charge Code |
2999937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$2,656.00 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.04
|
| Rate for Payer: Aetna Managed Medicare |
$185.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.57
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$431.60
|
| Rate for Payer: Quartz Medicare Advantage |
$398.40
|
| Rate for Payer: The Alliance Commercial |
$2,656.00
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
Temperature Probe Indwelling/Continuous - Urinary Catheter Type
|
Facility
IP
|
$664.00
|
|
| Hospital Charge Code |
2999937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.36 |
| Max. Negotiated Rate |
$610.88 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$398.40
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
Temperature Probe Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
IP
|
$664.00
|
|
| Hospital Charge Code |
5510859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.36 |
| Max. Negotiated Rate |
$610.88 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$398.40
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
Temperature Probe Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
OP
|
$664.00
|
|
| Hospital Charge Code |
5510859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$2,656.00 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.04
|
| Rate for Payer: Aetna Managed Medicare |
$185.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.57
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.00
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$431.60
|
| Rate for Payer: Quartz Medicare Advantage |
$398.40
|
| Rate for Payer: The Alliance Commercial |
$2,656.00
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
TEMPLATE BENDING MATRIX MIDFACE ORBITAL MESH 03.503.365
|
Facility
IP
|
$2,455.00
|
|
| Hospital Charge Code |
5349171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,202.95 |
| Max. Negotiated Rate |
$2,258.60 |
| Rate for Payer: Aetna Commercial |
$2,209.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.15
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,258.60
|
| Rate for Payer: Health EOS Commercial |
$2,184.95
|
| Rate for Payer: HFN Commercial |
$2,258.60
|
| Rate for Payer: Multiplan Commercial |
$1,964.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,473.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,258.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,202.95
|
| Rate for Payer: Quartz Commercial |
$1,473.00
|
| Rate for Payer: WEA Trust Commercial |
$1,350.25
|
| Rate for Payer: WPS Commercial |
$1,818.42
|
|
|
TEMPLATE BENDING MATRIX MIDFACE ORBITAL MESH 03.503.365
|
Facility
OP
|
$2,455.00
|
|
| Hospital Charge Code |
5349171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$687.40 |
| Max. Negotiated Rate |
$9,820.00 |
| Rate for Payer: Aetna Commercial |
$2,209.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,111.30
|
| Rate for Payer: Aetna Managed Medicare |
$687.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,595.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,227.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,178.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.15
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,258.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,373.82
|
| Rate for Payer: Health EOS Commercial |
$2,184.95
|
| Rate for Payer: HFN Commercial |
$2,258.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,841.25
|
| Rate for Payer: Multiplan Commercial |
$1,964.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,473.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,258.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,202.95
|
| Rate for Payer: Quartz Commercial |
$1,595.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,473.00
|
| Rate for Payer: The Alliance Commercial |
$9,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,350.25
|
| Rate for Payer: WPS Commercial |
$1,818.42
|
|
|
TEMPORARY FIXATION PIN 1.4MM LARGE ORTHOLOC 58820006
|
Facility
IP
|
$1,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.87 |
| Max. Negotiated Rate |
$1,437.96 |
| Rate for Payer: Aetna Commercial |
$1,406.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.39
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna Commercial |
$1,437.96
|
| Rate for Payer: Health EOS Commercial |
$1,391.07
|
| Rate for Payer: HFN Commercial |
$1,437.96
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$937.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,437.96
|
| Rate for Payer: Quartz Beloit One Network |
$765.87
|
| Rate for Payer: Quartz Commercial |
$937.80
|
| Rate for Payer: WEA Trust Commercial |
$859.65
|
| Rate for Payer: WPS Commercial |
$1,157.71
|
|
|
TEMPORARY FIXATION PIN 1.4MM LARGE ORTHOLOC 58820006
|
Facility
OP
|
$1,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$437.64 |
| Max. Negotiated Rate |
$1,437.96 |
| Rate for Payer: Aetna Commercial |
$1,406.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,344.18
|
| Rate for Payer: Aetna Managed Medicare |
$437.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,015.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$781.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.39
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna Commercial |
$1,437.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$874.65
|
| Rate for Payer: Health EOS Commercial |
$1,391.07
|
| Rate for Payer: HFN Commercial |
$1,437.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,172.25
|
| Rate for Payer: Multiplan Commercial |
$1,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$937.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,437.96
|
| Rate for Payer: Quartz Beloit One Network |
$765.87
|
| Rate for Payer: Quartz Commercial |
$1,015.95
|
| Rate for Payer: Quartz Medicare Advantage |
$937.80
|
| Rate for Payer: WEA Trust Commercial |
$859.65
|
| Rate for Payer: WPS Commercial |
$1,157.71
|
|
|
Temp Trancutaneous Pacing
|
Facility
IP
|
$251.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
5238878
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Temp Trancutaneous Pacing
|
Facility
OP
|
$251.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
5238878
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$2,393.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$643.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$163.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.48
|
| Rate for Payer: Anthem Medicare Advantage |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.28
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$643.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$643.28
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,393.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$643.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$643.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$643.28
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$964.92
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$643.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.28
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: Wellcare Medicare |
$643.28
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
IP
|
$41,709.00
|
|
|
Service Code
|
MS-DRG 557
|
| Min. Negotiated Rate |
$15,003.41 |
| Max. Negotiated Rate |
$41,709.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,003.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,728.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,086.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,833.68
|
| Rate for Payer: Anthem Medicare Advantage |
$15,003.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,003.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,003.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,003.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,457.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,003.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,357.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,003.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,003.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,003.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,003.41
|
| Rate for Payer: NAPHCARE Commercial |
$22,505.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15,003.41
|
| Rate for Payer: The Alliance Commercial |
$41,709.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,003.41
|
| Rate for Payer: United Healthcare PPO |
$23,633.78
|
| Rate for Payer: Wellcare Medicare |
$15,003.41
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
IP
|
$23,674.00
|
|
|
Service Code
|
MS-DRG 558
|
| Min. Negotiated Rate |
$8,515.65 |
| Max. Negotiated Rate |
$23,674.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,515.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,462.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,444.64
|
| Rate for Payer: Anthem Medicare Advantage |
$8,515.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,515.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,515.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,515.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,924.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,515.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,128.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,515.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,515.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,515.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,515.65
|
| Rate for Payer: NAPHCARE Commercial |
$12,773.48
|
| Rate for Payer: Quartz Medicare Advantage |
$8,515.65
|
| Rate for Payer: The Alliance Commercial |
$23,674.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,515.65
|
| Rate for Payer: United Healthcare PPO |
$13,334.99
|
| Rate for Payer: Wellcare Medicare |
$8,515.65
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
OP
|
$71,025.12
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$71,025.12 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$71,025.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
OP
|
$22,318.84
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
TENNIS ELBOW RELEASE
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
TENNIS ELBOW RELEASE
|
Facility
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
TENNIS ELBOW STRAP 12870000
|
Facility
OP
|
$179.00
|
|
| Hospital Charge Code |
2974287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
TENNIS ELBOW STRAP 12870000
|
Facility
IP
|
$179.00
|
|
| Hospital Charge Code |
2974287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
TENNIS ELBOW STRAP #NE7730-70
|
Facility
OP
|
$151.00
|
|
| Hospital Charge Code |
2969715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TENNIS ELBOW STRAP #NE7730-70
|
Facility
IP
|
$151.00
|
|
| Hospital Charge Code |
2969715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE)
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 24340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,546.14 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$14,527.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,071.12 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$15,495.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
|
Facility
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 28225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$10,829.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 26445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
|
Facility
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 27680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$6,125.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
