|
Temperature Probe Indwelling/Continuous* - Urinary catheter type:
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
5877765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Aetna Managed Medicare |
$193.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.45
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.92
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: NAPHCARE Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$448.86
|
| Rate for Payer: Quartz Medicare Advantage |
$414.34
|
| Rate for Payer: The Alliance Commercial |
$345.28
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Temperature Probe Indwelling/Continuous* - Urinary catheter type:
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
5877765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$414.34
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Temperature Probe Indwelling/Continuous - Urinary Catheter Type
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
2999937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$414.34
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Temperature Probe Indwelling/Continuous - Urinary Catheter Type
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
2999937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Aetna Managed Medicare |
$193.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.45
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.92
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: NAPHCARE Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$448.86
|
| Rate for Payer: Quartz Medicare Advantage |
$414.34
|
| Rate for Payer: The Alliance Commercial |
$345.28
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Temperature Probe Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
|
OP
|
$664.00
|
|
| Hospital Charge Code |
5510859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Aetna Managed Medicare |
$193.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.45
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.92
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: NAPHCARE Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$448.86
|
| Rate for Payer: Quartz Medicare Advantage |
$414.34
|
| Rate for Payer: The Alliance Commercial |
$345.28
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Temperature Probe Indwelling/Continuous* - Urinary Catheter Type:
|
Facility
|
IP
|
$664.00
|
|
| Hospital Charge Code |
5510859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$414.34
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
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 |
$1,251.07 |
| Max. Negotiated Rate |
$2,348.94 |
| Rate for Payer: Aetna Commercial |
$2,297.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.20
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,348.94
|
| Rate for Payer: Health EOS Commercial |
$2,272.35
|
| Rate for Payer: HFN Commercial |
$2,348.94
|
| Rate for Payer: Multiplan Commercial |
$2,042.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.07
|
| Rate for Payer: Quartz Commercial |
$1,531.92
|
| Rate for Payer: WEA Trust Commercial |
$1,404.26
|
| Rate for Payer: WPS Commercial |
$1,891.09
|
|
|
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 |
$714.90 |
| Max. Negotiated Rate |
$2,348.94 |
| Rate for Payer: Aetna Commercial |
$2,297.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.75
|
| Rate for Payer: Aetna Managed Medicare |
$714.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,659.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,276.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,225.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,353.20
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,348.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,428.81
|
| Rate for Payer: Health EOS Commercial |
$2,272.35
|
| Rate for Payer: HFN Commercial |
$2,348.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,914.90
|
| Rate for Payer: Multiplan Commercial |
$2,042.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,531.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,348.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.07
|
| Rate for Payer: Quartz Commercial |
$1,659.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,531.92
|
| Rate for Payer: The Alliance Commercial |
$1,276.60
|
| Rate for Payer: WEA Trust Commercial |
$1,404.26
|
| Rate for Payer: WPS Commercial |
$1,891.09
|
|
|
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 |
$455.15 |
| Max. Negotiated Rate |
$1,495.48 |
| Rate for Payer: Aetna Commercial |
$1,462.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,397.95
|
| Rate for Payer: Aetna Managed Medicare |
$455.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,056.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$812.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$780.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$861.53
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna Commercial |
$1,495.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$909.67
|
| Rate for Payer: Health EOS Commercial |
$1,446.71
|
| Rate for Payer: HFN Commercial |
$1,495.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,219.14
|
| Rate for Payer: Multiplan Commercial |
$1,300.42
|
| Rate for Payer: NAPHCARE Commercial |
$975.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,495.48
|
| Rate for Payer: Quartz Beloit One Network |
$796.50
|
| Rate for Payer: Quartz Commercial |
$1,056.59
|
| Rate for Payer: Quartz Medicare Advantage |
$975.31
|
| Rate for Payer: The Alliance Commercial |
$812.76
|
| Rate for Payer: WEA Trust Commercial |
$894.04
|
| Rate for Payer: WPS Commercial |
$1,203.98
|
|
|
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 |
$796.50 |
| Max. Negotiated Rate |
$1,495.48 |
| Rate for Payer: Aetna Commercial |
$1,462.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,397.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$861.53
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna Commercial |
$1,495.48
|
| Rate for Payer: Health EOS Commercial |
$1,446.71
|
| Rate for Payer: HFN Commercial |
$1,495.48
|
| Rate for Payer: Multiplan Commercial |
$1,300.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,495.48
|
| Rate for Payer: Quartz Beloit One Network |
$796.50
|
| Rate for Payer: Quartz Commercial |
$975.31
|
| Rate for Payer: WEA Trust Commercial |
$894.04
|
| Rate for Payer: WPS Commercial |
$1,203.98
|
|
|
Temp Trancutaneous Pacing
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
5238878
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$2,782.29 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$695.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.30
|
| Rate for Payer: Anthem Medicare Advantage |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.57
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.57
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,587.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.57
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.36
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$695.57
|
| Rate for Payer: The Alliance Commercial |
$2,782.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.57
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: Wellcare Medicare |
$695.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
Temp Trancutaneous Pacing
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
5238878
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$43,377.36
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$11,893.75 |
| Max. Negotiated Rate |
$43,377.36 |
| Rate for Payer: Aetna Managed Medicare |
$11,893.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,442.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,867.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,625.53
|
| Rate for Payer: Anthem Medicare Advantage |
$11,893.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,893.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,893.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,893.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,226.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,893.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,571.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,893.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,893.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,893.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,893.75
|
| Rate for Payer: NAPHCARE Commercial |
$17,840.63
|
| Rate for Payer: Quartz Medicare Advantage |
$11,893.75
|
| Rate for Payer: The Alliance Commercial |
$43,377.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,893.75
|
| Rate for Payer: United Healthcare PPO |
$24,579.13
|
| Rate for Payer: Wellcare Medicare |
$11,893.75
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$24,620.96
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$7,347.09 |
| Max. Negotiated Rate |
$24,620.96 |
| Rate for Payer: Aetna Managed Medicare |
$7,347.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,488.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,938.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,192.16
|
| Rate for Payer: Anthem Medicare Advantage |
$7,347.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,347.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,347.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,347.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,754.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,347.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,813.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,347.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,347.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,347.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,347.09
|
| Rate for Payer: NAPHCARE Commercial |
$11,020.64
|
| Rate for Payer: Quartz Medicare Advantage |
$7,347.09
|
| Rate for Payer: The Alliance Commercial |
$24,620.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,347.09
|
| Rate for Payer: United Healthcare PPO |
$13,868.39
|
| Rate for Payer: Wellcare Medicare |
$7,347.09
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$18,150.40
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$16,122.32 |
| Max. Negotiated Rate |
$18,150.40 |
| Rate for Payer: Anthem Medicaid |
$17,380.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,380.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,380.01
|
| Rate for Payer: Dean Health Medicaid |
$17,380.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,122.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18,150.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,380.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,380.01
|
| Rate for Payer: United Healthcare Medicaid |
$17,380.01
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$30,952.13
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$27,493.62 |
| Max. Negotiated Rate |
$30,952.13 |
| Rate for Payer: Anthem Medicaid |
$29,638.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$29,638.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29,638.37
|
| Rate for Payer: Dean Health Medicaid |
$29,638.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27,493.62
|
| Rate for Payer: Managed Health Services Medicaid |
$30,952.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,638.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29,638.37
|
| Rate for Payer: United Healthcare Medicaid |
$29,638.37
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$12,714.05
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$11,293.41 |
| Max. Negotiated Rate |
$12,714.05 |
| Rate for Payer: Anthem Medicaid |
$12,174.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,174.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,174.40
|
| Rate for Payer: Dean Health Medicaid |
$12,174.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,293.41
|
| Rate for Payer: Managed Health Services Medicaid |
$12,714.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,174.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,174.40
|
| Rate for Payer: United Healthcare Medicaid |
$12,174.40
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$9,557.46
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$8,489.53 |
| Max. Negotiated Rate |
$9,557.46 |
| Rate for Payer: Anthem Medicaid |
$9,151.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,151.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,151.79
|
| Rate for Payer: Dean Health Medicaid |
$9,151.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,489.53
|
| Rate for Payer: Managed Health Services Medicaid |
$9,557.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,151.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,151.79
|
| Rate for Payer: United Healthcare Medicaid |
$9,151.79
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
TENNIS ELBOW RELEASE
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
TENNIS ELBOW RELEASE
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
TENNIS ELBOW STRAP 12870000
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
2974287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
TENNIS ELBOW STRAP 12870000
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
2974287
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
TENNIS ELBOW STRAP #NE7730-70
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2969715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
