|
TRANFIXING PIN 5MM X 300MM 5050-5-300
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$393.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$912.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$702.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$673.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.70
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.00
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$912.60
|
| Rate for Payer: Quartz Medicare Advantage |
$842.40
|
| Rate for Payer: The Alliance Commercial |
$702.00
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
Transbronchial - Bronchoscopy Charge
|
Facility
|
IP
|
$4,954.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
2990186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,524.56 |
| Max. Negotiated Rate |
$4,739.99 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,091.30
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
Transbronchial - Bronchoscopy Charge
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
2990186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,524.56 |
| Max. Negotiated Rate |
$14,596.05 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| 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 |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,348.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$6,670.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
TRANSCATH IV STENT/PERC ADDL 37206
|
Professional
|
Both
|
$3,011.00
|
|
| Hospital Charge Code |
3014548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,377.83 |
| Max. Negotiated Rate |
$2,974.87 |
| Rate for Payer: Aetna Commercial |
$2,974.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.04
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,974.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,565.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.86
|
| Rate for Payer: Health EOS Commercial |
$2,849.61
|
| Rate for Payer: HFN Commercial |
$2,974.87
|
| Rate for Payer: Multiplan Commercial |
$2,505.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,974.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.83
|
| Rate for Payer: Quartz Commercial |
$1,784.92
|
| Rate for Payer: The Alliance Commercial |
$1,565.72
|
| Rate for Payer: WEA Trust Commercial |
$1,722.29
|
| Rate for Payer: WPS Commercial |
$2,319.37
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Transferrin
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Transferrin
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| 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 |
$13.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| 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 |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: United Healthcare PPO |
$139.62
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: Wellcare Medicare |
$13.27
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
Transferrin
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$176.85 |
| Rate for Payer: Aetna Commercial |
$176.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$176.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$169.41
|
| Rate for Payer: HFN Commercial |
$176.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$176.85
|
| Rate for Payer: Quartz Beloit One Network |
$81.91
|
| Rate for Payer: Quartz Commercial |
$106.11
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$52.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$58.39
|
|
|
Transferrin (CDT)
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Transferrin (CDT)
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$52.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.39
|
|
|
Transferrin (CDT)
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$13.27
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
|
IP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.87 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,144.34
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
|
OP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,467.36 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,467.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,406.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,932.70
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,930.42
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,144.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,406.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,144.34
|
| Rate for Payer: The Alliance Commercial |
$2,620.28
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
Transfusion Reaction Culture
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
Transfusion Reaction Culture
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
Transfusion Reaction Culture
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$9,294.41
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$8,255.87 |
| Max. Negotiated Rate |
$9,294.41 |
| Rate for Payer: Anthem Medicaid |
$8,899.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,899.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,899.91
|
| Rate for Payer: Dean Health Medicaid |
$8,899.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,255.87
|
| Rate for Payer: Managed Health Services Medicaid |
$9,294.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,899.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,899.91
|
| Rate for Payer: United Healthcare Medicaid |
$8,899.91
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$15,081.49
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$13,396.32 |
| Max. Negotiated Rate |
$15,081.49 |
| Rate for Payer: Anthem Medicaid |
$14,441.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,441.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,441.36
|
| Rate for Payer: Dean Health Medicaid |
$14,441.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,396.32
|
| Rate for Payer: Managed Health Services Medicaid |
$15,081.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,441.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,441.36
|
| Rate for Payer: United Healthcare Medicaid |
$14,441.36
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00526
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$22,417.20
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$6,624.14 |
| Max. Negotiated Rate |
$22,417.20 |
| Rate for Payer: Aetna Managed Medicare |
$6,624.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,429.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,359.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,692.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6,624.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,624.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,624.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,624.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,089.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,624.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,197.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,624.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,624.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,624.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,624.14
|
| Rate for Payer: NAPHCARE Commercial |
$9,936.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6,624.14
|
| Rate for Payer: The Alliance Commercial |
$22,417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,624.14
|
| Rate for Payer: United Healthcare PPO |
$12,610.06
|
| Rate for Payer: Wellcare Medicare |
$6,624.14
|
|
|
TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 36907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.93 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$484.93
|
|
