|
AAA EXTENSION PROSTHESES-DELAYED
|
Facility
|
OP
|
$37,569.00
|
|
|
Service Code
|
CPT 34710
|
| Hospital Charge Code |
5416680
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,519.32 |
| Max. Negotiated Rate |
$150,276.00 |
| Rate for Payer: Aetna Commercial |
$33,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,309.34
|
| Rate for Payer: Aetna Managed Medicare |
$10,519.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,419.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,784.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,911.57
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$34,563.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$33,436.41
|
| Rate for Payer: HFN Commercial |
$34,563.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,176.75
|
| Rate for Payer: Multiplan Commercial |
$30,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$22,541.40
|
| Rate for Payer: Preferred Network Access Commercial |
$34,563.48
|
| Rate for Payer: Quartz Beloit One Network |
$18,408.81
|
| Rate for Payer: Quartz Commercial |
$24,419.85
|
| Rate for Payer: Quartz Medicare Advantage |
$22,541.40
|
| Rate for Payer: The Alliance Commercial |
$150,276.00
|
| Rate for Payer: United Healthcare PPO |
$28,176.75
|
| Rate for Payer: WEA Trust Commercial |
$20,662.95
|
| Rate for Payer: WPS Commercial |
$27,827.36
|
|
|
AAA EXTENSION PROSTHESIS
|
Facility
|
OP
|
$39,014.00
|
|
|
Service Code
|
CPT 34709
|
| Hospital Charge Code |
5416679
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,923.92 |
| Max. Negotiated Rate |
$156,056.00 |
| Rate for Payer: Aetna Commercial |
$35,112.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,552.04
|
| Rate for Payer: Aetna Managed Medicare |
$10,923.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,359.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,507.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,726.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,677.42
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cigna Commercial |
$35,892.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$34,722.46
|
| Rate for Payer: HFN Commercial |
$35,892.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,260.50
|
| Rate for Payer: Multiplan Commercial |
$31,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$23,408.40
|
| Rate for Payer: Preferred Network Access Commercial |
$35,892.88
|
| Rate for Payer: Quartz Beloit One Network |
$19,116.86
|
| Rate for Payer: Quartz Commercial |
$25,359.10
|
| Rate for Payer: Quartz Medicare Advantage |
$23,408.40
|
| Rate for Payer: The Alliance Commercial |
$156,056.00
|
| Rate for Payer: United Healthcare PPO |
$29,260.50
|
| Rate for Payer: WEA Trust Commercial |
$21,457.70
|
| Rate for Payer: WPS Commercial |
$28,897.67
|
|
|
AAA EXTENSION PROSTHESIS
|
Facility
|
IP
|
$39,014.00
|
|
|
Service Code
|
CPT 34709
|
| Hospital Charge Code |
5416679
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19,116.86 |
| Max. Negotiated Rate |
$35,892.88 |
| Rate for Payer: Aetna Commercial |
$35,112.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,552.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,677.42
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cigna Commercial |
$35,892.88
|
| Rate for Payer: Health EOS Commercial |
$34,722.46
|
| Rate for Payer: HFN Commercial |
$35,892.88
|
| Rate for Payer: Multiplan Commercial |
$31,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$23,408.40
|
| Rate for Payer: Preferred Network Access Commercial |
$35,892.88
|
| Rate for Payer: Quartz Beloit One Network |
$19,116.86
|
| Rate for Payer: Quartz Commercial |
$23,408.40
|
| Rate for Payer: WEA Trust Commercial |
$21,457.70
|
| Rate for Payer: WPS Commercial |
$28,897.67
|
|
|
AAA FIXATON DEVICE(S) TO ENDOGRAFT
|
Facility
|
IP
|
$16,846.00
|
|
|
Service Code
|
CPT 34712
|
| Hospital Charge Code |
5581970
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,254.54 |
| Max. Negotiated Rate |
$15,498.32 |
| Rate for Payer: Aetna Commercial |
$15,161.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,487.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,928.38
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$15,498.32
|
| Rate for Payer: Health EOS Commercial |
$14,992.94
|
| Rate for Payer: HFN Commercial |
$15,498.32
|
| Rate for Payer: Multiplan Commercial |
$13,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,498.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,254.54
|
| Rate for Payer: Quartz Commercial |
$10,107.60
|
| Rate for Payer: WEA Trust Commercial |
$9,265.30
|
| Rate for Payer: WPS Commercial |
$12,477.83
|
|
|
AAA FIXATON DEVICE(S) TO ENDOGRAFT
|
Facility
|
OP
|
$16,846.00
|
|
|
Service Code
|
CPT 34712
|
| Hospital Charge Code |
5581970
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$67,384.00 |
| Rate for Payer: Aetna Commercial |
$15,161.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,487.56
|
| Rate for Payer: Aetna Managed Medicare |
$4,716.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,928.38
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$15,498.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$14,992.94
|
| Rate for Payer: HFN Commercial |
$15,498.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,634.50
|
| Rate for Payer: Multiplan Commercial |
$13,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,498.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,254.54
|
| Rate for Payer: Quartz Commercial |
$10,949.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,107.60
|
| Rate for Payer: The Alliance Commercial |
$67,384.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$9,265.30
|
| Rate for Payer: WPS Commercial |
$12,477.83
|
|
|
AAA GRAFT-MAIN BODY & BIL ILIAC
|
Facility
|
IP
|
$45,749.00
|
|
|
Service Code
|
CPT 34705
|
| Hospital Charge Code |
5416674
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$22,417.01 |
| Max. Negotiated Rate |
$42,089.08 |
| Rate for Payer: Aetna Commercial |
$41,174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,344.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,246.97
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cigna Commercial |
$42,089.08
|
| Rate for Payer: Health EOS Commercial |
$40,716.61
|
| Rate for Payer: HFN Commercial |
$42,089.08
|
| Rate for Payer: Multiplan Commercial |
$36,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$27,449.40
|
| Rate for Payer: Preferred Network Access Commercial |
$42,089.08
|
| Rate for Payer: Quartz Beloit One Network |
$22,417.01
|
| Rate for Payer: Quartz Commercial |
$27,449.40
|
| Rate for Payer: WEA Trust Commercial |
$25,161.95
|
| Rate for Payer: WPS Commercial |
$33,886.28
|
|
|
AAA GRAFT-MAIN BODY & BIL ILIAC
|
Facility
|
OP
|
$45,749.00
|
|
|
Service Code
|
CPT 34705
|
| Hospital Charge Code |
5416674
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,874.87 |
| Max. Negotiated Rate |
$182,996.00 |
| Rate for Payer: Aetna Commercial |
$41,174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,344.14
|
| Rate for Payer: Aetna Managed Medicare |
$12,809.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,736.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,874.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,959.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,246.97
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cigna Commercial |
$42,089.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$40,716.61
|
| Rate for Payer: HFN Commercial |
$42,089.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,311.75
|
| Rate for Payer: Multiplan Commercial |
$36,599.20
|
| Rate for Payer: NAPHCARE Commercial |
$27,449.40
|
| Rate for Payer: Preferred Network Access Commercial |
$42,089.08
|
| Rate for Payer: Quartz Beloit One Network |
$22,417.01
|
| Rate for Payer: Quartz Commercial |
$29,736.85
|
| Rate for Payer: Quartz Medicare Advantage |
$27,449.40
|
| Rate for Payer: The Alliance Commercial |
$182,996.00
|
| Rate for Payer: United Healthcare PPO |
$34,311.75
|
| Rate for Payer: WEA Trust Commercial |
$25,161.95
|
| Rate for Payer: WPS Commercial |
$33,886.28
|
|
|
AAA GRAFT-MAIN BODY ONLY
|
Facility
|
OP
|
$42,936.00
|
|
|
Service Code
|
CPT 34701
|
| Hospital Charge Code |
5416678
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,874.87 |
| Max. Negotiated Rate |
$171,744.00 |
| Rate for Payer: Aetna Commercial |
$38,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,924.96
|
| Rate for Payer: Aetna Managed Medicare |
$12,022.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,908.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,609.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,756.08
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$39,501.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$38,213.04
|
| Rate for Payer: HFN Commercial |
$39,501.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,202.00
|
| Rate for Payer: Multiplan Commercial |
$34,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39,501.12
|
| Rate for Payer: Quartz Beloit One Network |
$21,038.64
|
| Rate for Payer: Quartz Commercial |
$27,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$25,761.60
|
| Rate for Payer: The Alliance Commercial |
$171,744.00
|
| Rate for Payer: United Healthcare PPO |
$32,202.00
|
| Rate for Payer: WEA Trust Commercial |
$23,614.80
|
| Rate for Payer: WPS Commercial |
$31,802.70
|
|
|
AAA GRAFT-MAIN BODY ONLY
|
Facility
|
IP
|
$42,936.00
|
|
|
Service Code
|
CPT 34701
|
| Hospital Charge Code |
5416678
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21,038.64 |
| Max. Negotiated Rate |
$39,501.12 |
| Rate for Payer: Aetna Commercial |
$38,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,924.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,756.08
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$39,501.12
|
| Rate for Payer: Health EOS Commercial |
$38,213.04
|
| Rate for Payer: HFN Commercial |
$39,501.12
|
| Rate for Payer: Multiplan Commercial |
$34,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39,501.12
|
| Rate for Payer: Quartz Beloit One Network |
$21,038.64
|
| Rate for Payer: Quartz Commercial |
$25,761.60
|
| Rate for Payer: WEA Trust Commercial |
$23,614.80
|
| Rate for Payer: WPS Commercial |
$31,802.70
|
|
|
AAA GRAFT-MAIN BODY & UNI ILIAC
|
Facility
|
IP
|
$42,936.00
|
|
|
Service Code
|
CPT 34703
|
| Hospital Charge Code |
5416681
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21,038.64 |
| Max. Negotiated Rate |
$39,501.12 |
| Rate for Payer: Aetna Commercial |
$38,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,924.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,756.08
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$39,501.12
|
| Rate for Payer: Health EOS Commercial |
$38,213.04
|
| Rate for Payer: HFN Commercial |
$39,501.12
|
| Rate for Payer: Multiplan Commercial |
$34,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39,501.12
|
| Rate for Payer: Quartz Beloit One Network |
$21,038.64
|
| Rate for Payer: Quartz Commercial |
$25,761.60
|
| Rate for Payer: WEA Trust Commercial |
$23,614.80
|
| Rate for Payer: WPS Commercial |
$31,802.70
|
|
|
AAA GRAFT-MAIN BODY & UNI ILIAC
|
Facility
|
OP
|
$42,936.00
|
|
|
Service Code
|
CPT 34703
|
| Hospital Charge Code |
5416681
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$11,874.87 |
| Max. Negotiated Rate |
$171,744.00 |
| Rate for Payer: Aetna Commercial |
$38,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,924.96
|
| Rate for Payer: Aetna Managed Medicare |
$12,022.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,908.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,609.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,756.08
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$39,501.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$38,213.04
|
| Rate for Payer: HFN Commercial |
$39,501.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,202.00
|
| Rate for Payer: Multiplan Commercial |
$34,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39,501.12
|
| Rate for Payer: Quartz Beloit One Network |
$21,038.64
|
| Rate for Payer: Quartz Commercial |
$27,908.40
|
| Rate for Payer: Quartz Medicare Advantage |
$25,761.60
|
| Rate for Payer: The Alliance Commercial |
$171,744.00
|
| Rate for Payer: United Healthcare PPO |
$32,202.00
|
| Rate for Payer: WEA Trust Commercial |
$23,614.80
|
| Rate for Payer: WPS Commercial |
$31,802.70
|
|
|
AAA - ILIAC ARTERY BRANCHES GRAFT
|
Facility
|
IP
|
$12,936.00
|
|
|
Service Code
|
CPT 34717
|
| Hospital Charge Code |
5691625
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,338.64 |
| Max. Negotiated Rate |
$11,901.12 |
| Rate for Payer: Aetna Commercial |
$11,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,124.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,856.08
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cigna Commercial |
$11,901.12
|
| Rate for Payer: Health EOS Commercial |
$11,513.04
|
| Rate for Payer: HFN Commercial |
$11,901.12
|
| Rate for Payer: Multiplan Commercial |
$10,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,901.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,338.64
|
| Rate for Payer: Quartz Commercial |
$7,761.60
|
| Rate for Payer: WEA Trust Commercial |
$7,114.80
|
| Rate for Payer: WPS Commercial |
$9,581.70
|
|
|
AAA - ILIAC ARTERY BRANCHES GRAFT
|
Facility
|
OP
|
$12,936.00
|
|
|
Service Code
|
CPT 34717
|
| Hospital Charge Code |
5691625
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,622.08 |
| Max. Negotiated Rate |
$51,744.00 |
| Rate for Payer: Aetna Commercial |
$11,642.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,124.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,622.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,408.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,209.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,856.08
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cigna Commercial |
$11,901.12
|
| Rate for Payer: Health EOS Commercial |
$11,513.04
|
| Rate for Payer: HFN Commercial |
$11,901.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,702.00
|
| Rate for Payer: Multiplan Commercial |
$10,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,901.12
|
| Rate for Payer: Quartz Beloit One Network |
$6,338.64
|
| Rate for Payer: Quartz Commercial |
$8,408.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,761.60
|
| Rate for Payer: The Alliance Commercial |
$51,744.00
|
| Rate for Payer: WEA Trust Commercial |
$7,114.80
|
| Rate for Payer: WPS Commercial |
$9,581.70
|
|
|
AAA ILIAC GRAFT-UNI
|
Facility
|
OP
|
$37,569.00
|
|
|
Service Code
|
CPT 34707
|
| Hospital Charge Code |
5416682
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,519.32 |
| Max. Negotiated Rate |
$150,276.00 |
| Rate for Payer: Aetna Commercial |
$33,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,309.34
|
| Rate for Payer: Aetna Managed Medicare |
$10,519.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,419.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,784.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,033.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,911.57
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$34,563.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$33,436.41
|
| Rate for Payer: HFN Commercial |
$34,563.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,176.75
|
| Rate for Payer: Multiplan Commercial |
$30,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$22,541.40
|
| Rate for Payer: Preferred Network Access Commercial |
$34,563.48
|
| Rate for Payer: Quartz Beloit One Network |
$18,408.81
|
| Rate for Payer: Quartz Commercial |
$24,419.85
|
| Rate for Payer: Quartz Medicare Advantage |
$22,541.40
|
| Rate for Payer: The Alliance Commercial |
$150,276.00
|
| Rate for Payer: United Healthcare PPO |
$28,176.75
|
| Rate for Payer: WEA Trust Commercial |
$20,662.95
|
| Rate for Payer: WPS Commercial |
$27,827.36
|
|
|
AAA ILIAC GRAFT-UNI
|
Facility
|
IP
|
$37,569.00
|
|
|
Service Code
|
CPT 34707
|
| Hospital Charge Code |
5416682
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18,408.81 |
| Max. Negotiated Rate |
$34,563.48 |
| Rate for Payer: Aetna Commercial |
$33,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,309.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,911.57
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$34,563.48
|
| Rate for Payer: Health EOS Commercial |
$33,436.41
|
| Rate for Payer: HFN Commercial |
$34,563.48
|
| Rate for Payer: Multiplan Commercial |
$30,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$22,541.40
|
| Rate for Payer: Preferred Network Access Commercial |
$34,563.48
|
| Rate for Payer: Quartz Beloit One Network |
$18,408.81
|
| Rate for Payer: Quartz Commercial |
$22,541.40
|
| Rate for Payer: WEA Trust Commercial |
$20,662.95
|
| Rate for Payer: WPS Commercial |
$27,827.36
|
|
|
AAA PERCUTANEOUS ACCESS & CLOSURE
|
Facility
|
IP
|
$16,846.00
|
|
|
Service Code
|
CPT 34713
|
| Hospital Charge Code |
5581971
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,254.54 |
| Max. Negotiated Rate |
$15,498.32 |
| Rate for Payer: Aetna Commercial |
$15,161.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,487.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,928.38
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$15,498.32
|
| Rate for Payer: Health EOS Commercial |
$14,992.94
|
| Rate for Payer: HFN Commercial |
$15,498.32
|
| Rate for Payer: Multiplan Commercial |
$13,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,498.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,254.54
|
| Rate for Payer: Quartz Commercial |
$10,107.60
|
| Rate for Payer: WEA Trust Commercial |
$9,265.30
|
| Rate for Payer: WPS Commercial |
$12,477.83
|
|
|
AAA PERCUTANEOUS ACCESS & CLOSURE
|
Facility
|
OP
|
$16,846.00
|
|
|
Service Code
|
CPT 34713
|
| Hospital Charge Code |
5581971
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,716.88 |
| Max. Negotiated Rate |
$67,384.00 |
| Rate for Payer: Aetna Commercial |
$15,161.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,487.56
|
| Rate for Payer: Aetna Managed Medicare |
$4,716.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,949.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,423.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,086.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,928.38
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$15,498.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$14,992.94
|
| Rate for Payer: HFN Commercial |
$15,498.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,634.50
|
| Rate for Payer: Multiplan Commercial |
$13,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,498.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,254.54
|
| Rate for Payer: Quartz Commercial |
$10,949.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,107.60
|
| Rate for Payer: The Alliance Commercial |
$67,384.00
|
| Rate for Payer: WEA Trust Commercial |
$9,265.30
|
| Rate for Payer: WPS Commercial |
$12,477.83
|
|
|
Abatacept 10 mg charge
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$43.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.16
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.16
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$64.74
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$43.16
|
| Rate for Payer: The Alliance Commercial |
$172.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$43.16
|
| Rate for Payer: WPS Commercial |
$107.10
|
|
|
Abatacept 10 mg charge
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.43
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.84
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$107.10
|
|
|
Abatacept 10 mg charge
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Abatacept inj 10 mg J0129 man
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
3373582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Abatacept inj 10 mg J0129 man
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
3373582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$104.65
|
| Rate for Payer: HFN Commercial |
$109.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.43
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Preferred Network Access Commercial |
$109.25
|
| Rate for Payer: Quartz Beloit One Network |
$50.60
|
| Rate for Payer: Quartz Commercial |
$65.55
|
| Rate for Payer: The Alliance Commercial |
$57.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.84
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$107.10
|
|
|
Abatacept inj 10 mg J0129 man
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
3373582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$43.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.16
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.16
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$64.74
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$43.16
|
| Rate for Payer: The Alliance Commercial |
$172.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: Wellcare Medicare |
$43.16
|
| Rate for Payer: WPS Commercial |
$107.10
|
|
|
ABD dressing pad charge
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
2844895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
ABD dressing pad charge
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
2844895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
