|
ULTRASLING II SM ARM 11630005
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.07 |
| Max. Negotiated Rate |
$959.56 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$625.80
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
ULTRASLING II SM ARM 11630005
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$4,172.00 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Aetna Managed Medicare |
$292.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.66
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.25
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$677.95
|
| Rate for Payer: Quartz Medicare Advantage |
$625.80
|
| Rate for Payer: The Alliance Commercial |
$4,172.00
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
Ultrasonic guidance for needle
placement 7694226
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 76942 26
|
| Hospital Charge Code |
3121602
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.60
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| Rate for Payer: HFN Commercial |
$357.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.04
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: The Alliance Commercial |
$188.00
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$118,904.00
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$42,771.38 |
| Max. Negotiated Rate |
$118,904.00 |
| Rate for Payer: Aetna Managed Medicare |
$42,771.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93,570.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71,721.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68,139.88
|
| Rate for Payer: Anthem Medicare Advantage |
$42,771.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,771.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,771.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,771.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75,641.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,771.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,977.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,771.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,771.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,771.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,771.38
|
| Rate for Payer: NAPHCARE Commercial |
$64,157.07
|
| Rate for Payer: Quartz Medicare Advantage |
$42,771.38
|
| Rate for Payer: The Alliance Commercial |
$118,904.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,771.38
|
| Rate for Payer: United Healthcare PPO |
$67,713.33
|
| Rate for Payer: Wellcare Medicare |
$42,771.38
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$85,411.00
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$30,723.55 |
| Max. Negotiated Rate |
$85,411.00 |
| Rate for Payer: Aetna Managed Medicare |
$30,723.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,136.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,459.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,889.60
|
| Rate for Payer: Anthem Medicare Advantage |
$30,723.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,723.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,723.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,723.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,271.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,723.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62,411.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,723.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,723.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,723.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,723.55
|
| Rate for Payer: NAPHCARE Commercial |
$46,085.32
|
| Rate for Payer: Quartz Medicare Advantage |
$30,723.55
|
| Rate for Payer: The Alliance Commercial |
$85,411.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,723.55
|
| Rate for Payer: United Healthcare PPO |
$48,588.31
|
| Rate for Payer: Wellcare Medicare |
$30,723.55
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$82,072.00
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$29,522.39 |
| Max. Negotiated Rate |
$82,072.00 |
| Rate for Payer: Aetna Managed Medicare |
$29,522.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,618.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,529.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,056.24
|
| Rate for Payer: Anthem Medicare Advantage |
$29,522.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,522.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,522.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,522.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52,236.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,522.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,962.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,522.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,522.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,522.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,522.39
|
| Rate for Payer: NAPHCARE Commercial |
$44,283.58
|
| Rate for Payer: Quartz Medicare Advantage |
$29,522.39
|
| Rate for Payer: The Alliance Commercial |
$82,072.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,522.39
|
| Rate for Payer: United Healthcare PPO |
$46,681.58
|
| Rate for Payer: Wellcare Medicare |
$29,522.39
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS IN OR
|
Facility
|
IP
|
$479.00
|
|
| Hospital Charge Code |
2962836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS IN OR
|
Facility
|
OP
|
$479.00
|
|
| Hospital Charge Code |
2962836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,916.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.05
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: The Alliance Commercial |
$1,916.00
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
Ultrasound Guide For Radth
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
3040411
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$344.96 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$422.40
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
Ultrasound Guide For Radth
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
3040411
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$2,816.00 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Aetna Managed Medicare |
$197.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.96
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.00
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$457.60
|
| Rate for Payer: Quartz Medicare Advantage |
$422.40
|
| Rate for Payer: The Alliance Commercial |
$2,816.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
Ultrasound Pregnant Uterus; Limited
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1188876
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$287.27 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$199.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.00
|
| Rate for Payer: Health EOS Commercial |
$191.10
|
| Rate for Payer: HFN Commercial |
$199.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.27
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$199.50
|
| Rate for Payer: Quartz Beloit One Network |
$92.40
|
| Rate for Payer: Quartz Commercial |
$119.70
|
| Rate for Payer: The Alliance Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Umbilical Artery Catheter Insertion
|
Facility
|
OP
|
$2,192.00
|
|
| Hospital Charge Code |
3718168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.76 |
| Max. Negotiated Rate |
$8,768.00 |
| Rate for Payer: Aetna Commercial |
$1,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Aetna Managed Medicare |
$613.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,096.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,052.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.76
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,016.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.64
|
| Rate for Payer: Health EOS Commercial |
$1,950.88
|
| Rate for Payer: HFN Commercial |
$2,016.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,644.00
|
| Rate for Payer: Multiplan Commercial |
$1,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.08
|
| Rate for Payer: Quartz Commercial |
$1,424.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,315.20
|
| Rate for Payer: The Alliance Commercial |
$8,768.00
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
Umbilical Artery Catheter Insertion
|
Facility
|
IP
|
$2,192.00
|
|
| Hospital Charge Code |
3718168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,074.08 |
| Max. Negotiated Rate |
$2,016.64 |
| Rate for Payer: Aetna Commercial |
$1,972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.76
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,016.64
|
| Rate for Payer: Health EOS Commercial |
$1,950.88
|
| Rate for Payer: HFN Commercial |
$2,016.64
|
| Rate for Payer: Multiplan Commercial |
$1,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.08
|
| Rate for Payer: Quartz Commercial |
$1,315.20
|
| Rate for Payer: WEA Trust Commercial |
$1,205.60
|
| Rate for Payer: WPS Commercial |
$1,623.61
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$37,493.00
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$13,486.67 |
| Max. Negotiated Rate |
$37,493.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,486.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,372.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,513.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,389.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,486.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,486.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,486.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,486.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,743.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,486.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,264.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,486.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,486.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,486.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,486.67
|
| Rate for Payer: NAPHCARE Commercial |
$20,230.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13,486.67
|
| Rate for Payer: The Alliance Commercial |
$37,493.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,486.67
|
| Rate for Payer: United Healthcare PPO |
$21,226.07
|
| Rate for Payer: Wellcare Medicare |
$13,486.67
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$23,602.00
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$8,489.84 |
| Max. Negotiated Rate |
$23,602.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,489.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,462.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,444.64
|
| Rate for Payer: Anthem Medicare Advantage |
$8,489.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,489.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,489.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,489.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,924.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,489.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,076.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,489.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,489.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,489.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,489.84
|
| Rate for Payer: NAPHCARE Commercial |
$12,734.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8,489.84
|
| Rate for Payer: The Alliance Commercial |
$23,602.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,489.84
|
| Rate for Payer: United Healthcare PPO |
$13,294.00
|
| Rate for Payer: Wellcare Medicare |
$8,489.84
|
|
|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,512.59 |
| Max. Negotiated Rate |
$12,227.72 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$7,974.60
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,721.48 |
| Max. Negotiated Rate |
$53,164.00 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,639.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,437.64
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,968.25
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$8,639.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.60
|
| Rate for Payer: The Alliance Commercial |
$53,164.00
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
|
OP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,135.96 |
| Max. Negotiated Rate |
$16,228.00 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,135.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,637.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,028.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,947.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,270.30
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,042.75
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,637.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,434.20
|
| Rate for Payer: The Alliance Commercial |
$16,228.00
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
|
IP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,987.93 |
| Max. Negotiated Rate |
$3,732.44 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,434.20
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,266.00 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,266.00 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
|
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,477.44 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,033.60
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
|
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,829.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,286.40
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
