|
SYNDESMOSIS FIXATION DEVICE W # 5 SUTURE GRAVITY SYNCHFIX 86SYN005
|
Facility
|
IP
|
$6,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,376.10 |
| Max. Negotiated Rate |
$6,338.80 |
| Rate for Payer: Aetna Commercial |
$6,201.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,925.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,651.70
|
| Rate for Payer: Cash Price |
$1,987.50
|
| Rate for Payer: Cigna Commercial |
$6,338.80
|
| Rate for Payer: Health EOS Commercial |
$6,132.10
|
| Rate for Payer: HFN Commercial |
$6,338.80
|
| Rate for Payer: Multiplan Commercial |
$5,512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,338.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,376.10
|
| Rate for Payer: Quartz Commercial |
$4,134.00
|
| Rate for Payer: WEA Trust Commercial |
$3,789.50
|
| Rate for Payer: WPS Commercial |
$5,103.24
|
|
|
SYNDESMOSIS FIXATION DEVICE W # 5 SUTURE GRAVITY SYNCHFIX 86SYN005
|
Facility
|
OP
|
$6,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,929.20 |
| Max. Negotiated Rate |
$6,338.80 |
| Rate for Payer: Aetna Commercial |
$6,201.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,925.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,929.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,478.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,445.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,307.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,651.70
|
| Rate for Payer: Cash Price |
$1,987.50
|
| Rate for Payer: Cigna Commercial |
$6,338.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,855.75
|
| Rate for Payer: Health EOS Commercial |
$6,132.10
|
| Rate for Payer: HFN Commercial |
$6,338.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,167.50
|
| Rate for Payer: Multiplan Commercial |
$5,512.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,134.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,338.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,376.10
|
| Rate for Payer: Quartz Commercial |
$4,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,134.00
|
| Rate for Payer: The Alliance Commercial |
$3,445.00
|
| Rate for Payer: WEA Trust Commercial |
$3,789.50
|
| Rate for Payer: WPS Commercial |
$5,103.24
|
|
|
SYNOVECTOMY
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
SYNOVECTOMY
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
Synovectomy, extensor tendon sheath, wrist, single compartment;
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 25118
|
|
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
|
|
|
SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28086
|
|
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 |
$4,947.89
|
| 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
|
|
|
SYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVECTOMY), FLEXOR TENDON, PALM AND/OR FINGER, EACH TENDON
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 26145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| 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 |
$6,807.99
|
| 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
|
|
|
Synthesis Rate IgG CSF
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
2959003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$17.89
|
| Rate for Payer: Anthem Medicare Advantage |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.89
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$270.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.89
|
| Rate for Payer: Health EOS Commercial |
$259.31
|
| Rate for Payer: HFN Commercial |
$270.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.89
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$26.83
|
| Rate for Payer: Preferred Network Access Commercial |
$270.71
|
| Rate for Payer: Quartz Beloit One Network |
$125.38
|
| Rate for Payer: Quartz Commercial |
$162.43
|
| Rate for Payer: Quartz Medicare Advantage |
$17.89
|
| Rate for Payer: The Alliance Commercial |
$70.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.89
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$78.71
|
|
|
Synthesis Rate IgG CSF
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
2959003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.69
|
| Rate for Payer: Anthem Medicare Advantage |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.89
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.89
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.89
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$26.83
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$17.89
|
| Rate for Payer: The Alliance Commercial |
$71.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.89
|
| Rate for Payer: United Healthcare PPO |
$213.72
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: Wellcare Medicare |
$17.89
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Synthesis Rate IgG CSF
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
2959003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Synthetic Cannabinoids Screen w/ Confirmation, Urine
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5274914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$228.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$255.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$284.35
|
|
|
Synthetic Cannabinoids Screen w/ Confirmation, Urine
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5274914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Synthetic Cannabinoids Screen w/ Confirmation, Urine
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5274914
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$64.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.63
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.63
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$96.94
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$64.63
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.63
|
| Rate for Payer: United Healthcare PPO |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: Wellcare Medicare |
$64.63
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Synvisc 1 mg Charge
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
2958943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.26
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$25.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$6.26
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc 1 mg Charge
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
2958943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.23
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicaid |
$7.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc 1 mg Charge
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
2958943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Synvisc 1 mg J7325 man
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
3373639
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.23
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicaid |
$7.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc 1 mg J7325 man
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
3373639
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.26
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$25.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$6.26
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc 1 mg J7325 man
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
3373639
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Synvisc Charge 1mg
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Synvisc Charge 1mg
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.23
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicaid |
$7.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc Charge 1mg
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.26
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$25.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$6.26
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc-One Charge 1mg
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Synvisc-One Charge 1mg
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.23
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicaid |
$7.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
|
Synvisc-One Charge 1mg
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4506645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.26
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.26
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.26
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$9.39
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6.26
|
| Rate for Payer: The Alliance Commercial |
$25.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.26
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: Wellcare Medicare |
$6.26
|
| Rate for Payer: WPS Commercial |
$23.08
|
|
