|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$973.44 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$912.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.98
|
| Rate for Payer: Anthem Medicare Advantage |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.36
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$243.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$243.36
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$243.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$365.04
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$243.36
|
| Rate for Payer: The Alliance Commercial |
$973.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.36
|
| Rate for Payer: United Healthcare PPO |
$558.48
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: Wellcare Medicare |
$243.36
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ULNAR COLATERAL LIGAMENT RECONSTRUCTION
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
ULNAR COLATERAL LIGAMENT RECONSTRUCTION
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
Ulnar Gutter Splint Custom
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
2989889
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,357.85 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$83.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.08
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$178.46
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$178.46
|
| Rate for Payer: The Alliance Commercial |
$2,357.85
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Ulnar Gutter Splint Custom
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
2989889
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
ULNAR NERVE RELEASE
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
ULNAR NERVE RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
ULTRABAG 2.5L 4.25% #5B9898P
|
Facility
|
OP
|
$184.00
|
|
| Hospital Charge Code |
2971654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$53.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$114.82
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
ULTRABAG 2.5L 4.25% #5B9898P
|
Facility
|
IP
|
$184.00
|
|
| Hospital Charge Code |
2971654
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
ULTRASLING II LG ARM 11630007
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
ULTRASLING II LG ARM 11630007
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$303.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.54
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$650.83
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$650.83
|
| Rate for Payer: The Alliance Commercial |
$528.94
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
ULTRASLING II MED ARM 11630006
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
ULTRASLING II MED ARM 11630006
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
2965896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$303.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.54
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$650.83
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$650.83
|
| Rate for Payer: The Alliance Commercial |
$528.94
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
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 |
$80.37 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$303.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.54
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$650.83
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$650.83
|
| Rate for Payer: The Alliance Commercial |
$528.94
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
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 |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
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 |
$31.55 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$31.55
|
| Rate for Payer: Anthem Medicare Advantage |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.55
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.55
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.55
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$47.33
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$31.55
|
| Rate for Payer: The Alliance Commercial |
$119.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.55
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$123,660.16
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$43,133.83 |
| Max. Negotiated Rate |
$123,660.16 |
| Rate for Payer: Aetna Managed Medicare |
$43,133.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121,450.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93,090.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88,442.02
|
| Rate for Payer: Anthem Medicare Advantage |
$43,133.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,133.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,133.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,133.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98,178.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,133.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90,456.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,133.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,133.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,133.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,133.83
|
| Rate for Payer: NAPHCARE Commercial |
$64,700.75
|
| Rate for Payer: Quartz Medicare Advantage |
$43,133.83
|
| Rate for Payer: The Alliance Commercial |
$123,660.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,133.83
|
| Rate for Payer: United Healthcare PPO |
$70,421.86
|
| Rate for Payer: Wellcare Medicare |
$43,133.83
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$88,827.44
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$28,125.29 |
| Max. Negotiated Rate |
$88,827.44 |
| Rate for Payer: Aetna Managed Medicare |
$28,125.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78,688.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,314.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,302.52
|
| Rate for Payer: Anthem Medicare Advantage |
$28,125.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,125.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,125.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,125.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,611.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,125.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,908.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,125.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,125.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,125.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,125.29
|
| Rate for Payer: NAPHCARE Commercial |
$42,187.94
|
| Rate for Payer: Quartz Medicare Advantage |
$28,125.29
|
| Rate for Payer: The Alliance Commercial |
$88,827.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,125.29
|
| Rate for Payer: United Healthcare PPO |
$50,531.84
|
| Rate for Payer: Wellcare Medicare |
$28,125.29
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$85,354.88
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$23,300.64 |
| Max. Negotiated Rate |
$85,354.88 |
| Rate for Payer: Aetna Managed Medicare |
$23,300.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,942.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,778.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,292.38
|
| Rate for Payer: Anthem Medicare Advantage |
$23,300.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,300.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,300.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,300.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52,498.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,300.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62,361.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,300.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,300.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,300.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,300.64
|
| Rate for Payer: NAPHCARE Commercial |
$34,950.96
|
| Rate for Payer: Quartz Medicare Advantage |
$23,300.64
|
| Rate for Payer: The Alliance Commercial |
$85,354.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,300.64
|
| Rate for Payer: United Healthcare PPO |
$48,548.84
|
| Rate for Payer: Wellcare Medicare |
$23,300.64
|
|
|
ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$23.35
|
|
|
Service Code
|
EAPG 00472
|
| Min. Negotiated Rate |
$22.46 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Anthem Medicaid |
$22.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.46
|
| Rate for Payer: Dean Health Medicaid |
$22.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.46
|
| Rate for Payer: Managed Health Services Medicaid |
$23.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.46
|
| Rate for Payer: United Healthcare Medicaid |
$22.46
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS IN OR
|
Facility
|
OP
|
$479.00
|
|
| Hospital Charge Code |
2962836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS IN OR
|
Facility
|
IP
|
$479.00
|
|
| Hospital Charge Code |
2962836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
Ultrasound Guide For Radth
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
3040411
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$358.76 |
| Max. Negotiated Rate |
$673.59 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$439.30
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
