|
AAA EXTENSION PROSTHESES-DELAYED
|
Facility
|
OP
|
$37,569.00
|
|
|
Service Code
|
CPT 34710
|
| Hospital Charge Code |
5416680
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,634.94 |
| Max. Negotiated Rate |
$35,946.02 |
| Rate for Payer: Aetna Commercial |
$35,164.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,601.71
|
| Rate for Payer: Aetna Managed Medicare |
$10,940.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,396.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,535.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,754.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,708.03
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$35,946.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$34,773.87
|
| Rate for Payer: HFN Commercial |
$35,946.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,303.82
|
| Rate for Payer: Multiplan Commercial |
$31,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$23,443.06
|
| Rate for Payer: Preferred Network Access Commercial |
$35,946.02
|
| Rate for Payer: Quartz Beloit One Network |
$19,145.16
|
| Rate for Payer: Quartz Commercial |
$25,396.64
|
| Rate for Payer: Quartz Medicare Advantage |
$23,443.06
|
| Rate for Payer: The Alliance Commercial |
$2,634.94
|
| Rate for Payer: United Healthcare PPO |
$29,303.82
|
| Rate for Payer: WEA Trust Commercial |
$21,489.47
|
| Rate for Payer: WPS Commercial |
$28,939.40
|
|
|
AAA EXTENSION PROSTHESIS
|
Facility
|
OP
|
$39,014.00
|
|
|
Service Code
|
CPT 34709
|
| Hospital Charge Code |
5416679
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,043.49 |
| Max. Negotiated Rate |
$37,328.60 |
| Rate for Payer: Aetna Commercial |
$36,517.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,894.12
|
| Rate for Payer: Aetna Managed Medicare |
$11,360.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,373.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,287.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,475.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,504.52
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cigna Commercial |
$37,328.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$36,111.36
|
| Rate for Payer: HFN Commercial |
$37,328.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,430.92
|
| Rate for Payer: Multiplan Commercial |
$32,459.65
|
| Rate for Payer: NAPHCARE Commercial |
$24,344.74
|
| Rate for Payer: Preferred Network Access Commercial |
$37,328.60
|
| Rate for Payer: Quartz Beloit One Network |
$19,881.53
|
| Rate for Payer: Quartz Commercial |
$26,373.46
|
| Rate for Payer: Quartz Medicare Advantage |
$24,344.74
|
| Rate for Payer: The Alliance Commercial |
$1,043.49
|
| Rate for Payer: United Healthcare PPO |
$30,430.92
|
| Rate for Payer: WEA Trust Commercial |
$22,316.01
|
| Rate for Payer: WPS Commercial |
$30,052.48
|
|
|
AAA EXTENSION PROSTHESIS
|
Facility
|
IP
|
$39,014.00
|
|
|
Service Code
|
CPT 34709
|
| Hospital Charge Code |
5416679
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19,881.53 |
| Max. Negotiated Rate |
$37,328.60 |
| Rate for Payer: Aetna Commercial |
$36,517.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,894.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,504.52
|
| Rate for Payer: Cash Price |
$11,704.20
|
| Rate for Payer: Cigna Commercial |
$37,328.60
|
| Rate for Payer: Health EOS Commercial |
$36,111.36
|
| Rate for Payer: HFN Commercial |
$37,328.60
|
| Rate for Payer: Multiplan Commercial |
$32,459.65
|
| Rate for Payer: Preferred Network Access Commercial |
$37,328.60
|
| Rate for Payer: Quartz Beloit One Network |
$19,881.53
|
| Rate for Payer: Quartz Commercial |
$24,344.74
|
| Rate for Payer: WEA Trust Commercial |
$22,316.01
|
| Rate for Payer: WPS Commercial |
$30,052.48
|
|
|
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 |
$2,172.19 |
| Max. Negotiated Rate |
$16,118.25 |
| Rate for Payer: Aetna Commercial |
$15,767.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,067.06
|
| Rate for Payer: Aetna Managed Medicare |
$4,905.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,285.52
|
| 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 |
$16,118.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$15,592.66
|
| Rate for Payer: HFN Commercial |
$16,118.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,139.88
|
| Rate for Payer: Multiplan Commercial |
$14,015.87
|
| Rate for Payer: NAPHCARE Commercial |
$10,511.90
|
| Rate for Payer: Preferred Network Access Commercial |
$16,118.25
|
| Rate for Payer: Quartz Beloit One Network |
$8,584.72
|
| Rate for Payer: Quartz Commercial |
$11,387.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,511.90
|
| Rate for Payer: The Alliance Commercial |
$2,172.19
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$9,635.91
|
| Rate for Payer: WPS Commercial |
$12,976.47
|
|
|
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 |
$8,584.72 |
| Max. Negotiated Rate |
$16,118.25 |
| Rate for Payer: Aetna Commercial |
$15,767.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,067.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,285.52
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$16,118.25
|
| Rate for Payer: Health EOS Commercial |
$15,592.66
|
| Rate for Payer: HFN Commercial |
$16,118.25
|
| Rate for Payer: Multiplan Commercial |
$14,015.87
|
| Rate for Payer: Preferred Network Access Commercial |
$16,118.25
|
| Rate for Payer: Quartz Beloit One Network |
$8,584.72
|
| Rate for Payer: Quartz Commercial |
$10,511.90
|
| Rate for Payer: WEA Trust Commercial |
$9,635.91
|
| Rate for Payer: WPS Commercial |
$12,976.47
|
|
|
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 |
$4,995.12 |
| Max. Negotiated Rate |
$43,772.64 |
| Rate for Payer: Aetna Commercial |
$42,821.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,917.91
|
| Rate for Payer: Aetna Managed Medicare |
$13,322.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,926.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,789.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,837.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,216.85
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cigna Commercial |
$43,772.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$42,345.27
|
| Rate for Payer: HFN Commercial |
$43,772.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,684.22
|
| Rate for Payer: Multiplan Commercial |
$38,063.17
|
| Rate for Payer: NAPHCARE Commercial |
$28,547.38
|
| Rate for Payer: Preferred Network Access Commercial |
$43,772.64
|
| Rate for Payer: Quartz Beloit One Network |
$23,313.69
|
| Rate for Payer: Quartz Commercial |
$30,926.32
|
| Rate for Payer: Quartz Medicare Advantage |
$28,547.38
|
| Rate for Payer: The Alliance Commercial |
$4,995.12
|
| Rate for Payer: United Healthcare PPO |
$35,684.22
|
| Rate for Payer: WEA Trust Commercial |
$26,168.43
|
| Rate for Payer: WPS Commercial |
$35,240.45
|
|
|
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 |
$23,313.69 |
| Max. Negotiated Rate |
$43,772.64 |
| Rate for Payer: Aetna Commercial |
$42,821.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,917.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,216.85
|
| Rate for Payer: Cash Price |
$13,724.70
|
| Rate for Payer: Cigna Commercial |
$43,772.64
|
| Rate for Payer: Health EOS Commercial |
$42,345.27
|
| Rate for Payer: HFN Commercial |
$43,772.64
|
| Rate for Payer: Multiplan Commercial |
$38,063.17
|
| Rate for Payer: Preferred Network Access Commercial |
$43,772.64
|
| Rate for Payer: Quartz Beloit One Network |
$23,313.69
|
| Rate for Payer: Quartz Commercial |
$28,547.38
|
| Rate for Payer: WEA Trust Commercial |
$26,168.43
|
| Rate for Payer: WPS Commercial |
$35,240.45
|
|
|
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 |
$21,880.19 |
| Max. Negotiated Rate |
$41,081.16 |
| Rate for Payer: Aetna Commercial |
$40,188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38,401.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,666.32
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$41,081.16
|
| Rate for Payer: Health EOS Commercial |
$39,741.56
|
| Rate for Payer: HFN Commercial |
$41,081.16
|
| Rate for Payer: Multiplan Commercial |
$35,722.75
|
| Rate for Payer: Preferred Network Access Commercial |
$41,081.16
|
| Rate for Payer: Quartz Beloit One Network |
$21,880.19
|
| Rate for Payer: Quartz Commercial |
$26,792.06
|
| Rate for Payer: WEA Trust Commercial |
$24,559.39
|
| Rate for Payer: WPS Commercial |
$33,073.60
|
|
|
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 |
$4,060.16 |
| Max. Negotiated Rate |
$41,081.16 |
| Rate for Payer: Aetna Commercial |
$40,188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38,401.96
|
| Rate for Payer: Aetna Managed Medicare |
$12,502.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,024.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,326.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,433.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,666.32
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$41,081.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$39,741.56
|
| Rate for Payer: HFN Commercial |
$41,081.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,490.08
|
| Rate for Payer: Multiplan Commercial |
$35,722.75
|
| Rate for Payer: NAPHCARE Commercial |
$26,792.06
|
| Rate for Payer: Preferred Network Access Commercial |
$41,081.16
|
| Rate for Payer: Quartz Beloit One Network |
$21,880.19
|
| Rate for Payer: Quartz Commercial |
$29,024.74
|
| Rate for Payer: Quartz Medicare Advantage |
$26,792.06
|
| Rate for Payer: The Alliance Commercial |
$4,060.16
|
| Rate for Payer: United Healthcare PPO |
$33,490.08
|
| Rate for Payer: WEA Trust Commercial |
$24,559.39
|
| Rate for Payer: WPS Commercial |
$33,073.60
|
|
|
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 |
$4,497.88 |
| Max. Negotiated Rate |
$41,081.16 |
| Rate for Payer: Aetna Commercial |
$40,188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38,401.96
|
| Rate for Payer: Aetna Managed Medicare |
$12,502.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,024.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,326.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,433.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,666.32
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$41,081.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$39,741.56
|
| Rate for Payer: HFN Commercial |
$41,081.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,490.08
|
| Rate for Payer: Multiplan Commercial |
$35,722.75
|
| Rate for Payer: NAPHCARE Commercial |
$26,792.06
|
| Rate for Payer: Preferred Network Access Commercial |
$41,081.16
|
| Rate for Payer: Quartz Beloit One Network |
$21,880.19
|
| Rate for Payer: Quartz Commercial |
$29,024.74
|
| Rate for Payer: Quartz Medicare Advantage |
$26,792.06
|
| Rate for Payer: The Alliance Commercial |
$4,497.88
|
| Rate for Payer: United Healthcare PPO |
$33,490.08
|
| Rate for Payer: WEA Trust Commercial |
$24,559.39
|
| Rate for Payer: WPS Commercial |
$33,073.60
|
|
|
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 |
$21,880.19 |
| Max. Negotiated Rate |
$41,081.16 |
| Rate for Payer: Aetna Commercial |
$40,188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38,401.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,666.32
|
| Rate for Payer: Cash Price |
$12,880.80
|
| Rate for Payer: Cigna Commercial |
$41,081.16
|
| Rate for Payer: Health EOS Commercial |
$39,741.56
|
| Rate for Payer: HFN Commercial |
$41,081.16
|
| Rate for Payer: Multiplan Commercial |
$35,722.75
|
| Rate for Payer: Preferred Network Access Commercial |
$41,081.16
|
| Rate for Payer: Quartz Beloit One Network |
$21,880.19
|
| Rate for Payer: Quartz Commercial |
$26,792.06
|
| Rate for Payer: WEA Trust Commercial |
$24,559.39
|
| Rate for Payer: WPS Commercial |
$33,073.60
|
|
|
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 |
$1,433.00 |
| Max. Negotiated Rate |
$12,377.16 |
| Rate for Payer: Aetna Commercial |
$12,108.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,569.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,766.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,744.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,726.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,457.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,130.32
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cigna Commercial |
$12,377.16
|
| Rate for Payer: Health EOS Commercial |
$11,973.56
|
| Rate for Payer: HFN Commercial |
$12,377.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,090.08
|
| Rate for Payer: Multiplan Commercial |
$10,762.75
|
| Rate for Payer: NAPHCARE Commercial |
$8,072.06
|
| Rate for Payer: Preferred Network Access Commercial |
$12,377.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,592.19
|
| Rate for Payer: Quartz Commercial |
$8,744.74
|
| Rate for Payer: Quartz Medicare Advantage |
$8,072.06
|
| Rate for Payer: The Alliance Commercial |
$1,433.00
|
| Rate for Payer: WEA Trust Commercial |
$7,399.39
|
| Rate for Payer: WPS Commercial |
$9,964.60
|
|
|
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 |
$6,592.19 |
| Max. Negotiated Rate |
$12,377.16 |
| Rate for Payer: Aetna Commercial |
$12,108.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,569.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,130.32
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: Cigna Commercial |
$12,377.16
|
| Rate for Payer: Health EOS Commercial |
$11,973.56
|
| Rate for Payer: HFN Commercial |
$12,377.16
|
| Rate for Payer: Multiplan Commercial |
$10,762.75
|
| Rate for Payer: Preferred Network Access Commercial |
$12,377.16
|
| Rate for Payer: Quartz Beloit One Network |
$6,592.19
|
| Rate for Payer: Quartz Commercial |
$8,072.06
|
| Rate for Payer: WEA Trust Commercial |
$7,399.39
|
| Rate for Payer: WPS Commercial |
$9,964.60
|
|
|
AAA ILIAC GRAFT-UNI
|
Facility
|
OP
|
$37,569.00
|
|
|
Service Code
|
CPT 34707
|
| Hospital Charge Code |
5416682
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,824.04 |
| Max. Negotiated Rate |
$35,946.02 |
| Rate for Payer: Aetna Commercial |
$35,164.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,601.71
|
| Rate for Payer: Aetna Managed Medicare |
$10,940.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,396.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,535.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,754.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,708.03
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$35,946.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$34,773.87
|
| Rate for Payer: HFN Commercial |
$35,946.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,303.82
|
| Rate for Payer: Multiplan Commercial |
$31,257.41
|
| Rate for Payer: NAPHCARE Commercial |
$23,443.06
|
| Rate for Payer: Preferred Network Access Commercial |
$35,946.02
|
| Rate for Payer: Quartz Beloit One Network |
$19,145.16
|
| Rate for Payer: Quartz Commercial |
$25,396.64
|
| Rate for Payer: Quartz Medicare Advantage |
$23,443.06
|
| Rate for Payer: The Alliance Commercial |
$3,824.04
|
| Rate for Payer: United Healthcare PPO |
$29,303.82
|
| Rate for Payer: WEA Trust Commercial |
$21,489.47
|
| Rate for Payer: WPS Commercial |
$28,939.40
|
|
|
AAA ILIAC GRAFT-UNI
|
Facility
|
IP
|
$37,569.00
|
|
|
Service Code
|
CPT 34707
|
| Hospital Charge Code |
5416682
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$19,145.16 |
| Max. Negotiated Rate |
$35,946.02 |
| Rate for Payer: Aetna Commercial |
$35,164.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,601.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,708.03
|
| Rate for Payer: Cash Price |
$11,270.70
|
| Rate for Payer: Cigna Commercial |
$35,946.02
|
| Rate for Payer: Health EOS Commercial |
$34,773.87
|
| Rate for Payer: HFN Commercial |
$35,946.02
|
| Rate for Payer: Multiplan Commercial |
$31,257.41
|
| Rate for Payer: Preferred Network Access Commercial |
$35,946.02
|
| Rate for Payer: Quartz Beloit One Network |
$19,145.16
|
| Rate for Payer: Quartz Commercial |
$23,443.06
|
| Rate for Payer: WEA Trust Commercial |
$21,489.47
|
| Rate for Payer: WPS Commercial |
$28,939.40
|
|
|
AAA PERCUTANEOUS ACCESS & CLOSURE
|
Facility
|
OP
|
$16,846.00
|
|
|
Service Code
|
CPT 34713
|
| Hospital Charge Code |
5581971
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$399.32 |
| Max. Negotiated Rate |
$16,118.25 |
| Rate for Payer: Aetna Commercial |
$15,767.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,067.06
|
| Rate for Payer: Aetna Managed Medicare |
$4,905.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,387.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,759.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,409.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,285.52
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$16,118.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$15,592.66
|
| Rate for Payer: HFN Commercial |
$16,118.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,139.88
|
| Rate for Payer: Multiplan Commercial |
$14,015.87
|
| Rate for Payer: NAPHCARE Commercial |
$10,511.90
|
| Rate for Payer: Preferred Network Access Commercial |
$16,118.25
|
| Rate for Payer: Quartz Beloit One Network |
$8,584.72
|
| Rate for Payer: Quartz Commercial |
$11,387.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,511.90
|
| Rate for Payer: The Alliance Commercial |
$399.32
|
| Rate for Payer: WEA Trust Commercial |
$9,635.91
|
| Rate for Payer: WPS Commercial |
$12,976.47
|
|
|
AAA PERCUTANEOUS ACCESS & CLOSURE
|
Facility
|
IP
|
$16,846.00
|
|
|
Service Code
|
CPT 34713
|
| Hospital Charge Code |
5581971
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,584.72 |
| Max. Negotiated Rate |
$16,118.25 |
| Rate for Payer: Aetna Commercial |
$15,767.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,067.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,285.52
|
| Rate for Payer: Cash Price |
$5,053.80
|
| Rate for Payer: Cigna Commercial |
$16,118.25
|
| Rate for Payer: Health EOS Commercial |
$15,592.66
|
| Rate for Payer: HFN Commercial |
$16,118.25
|
| Rate for Payer: Multiplan Commercial |
$14,015.87
|
| Rate for Payer: Preferred Network Access Commercial |
$16,118.25
|
| Rate for Payer: Quartz Beloit One Network |
$8,584.72
|
| Rate for Payer: Quartz Commercial |
$10,511.90
|
| Rate for Payer: WEA Trust Commercial |
$9,635.91
|
| Rate for Payer: WPS Commercial |
$12,976.47
|
|
|
Abatacept 10 mg charge
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$46.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.56
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$69.84
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$46.56
|
| Rate for Payer: The Alliance Commercial |
$186.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.56
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$46.56
|
| Rate for Payer: WPS Commercial |
$111.38
|
|
|
Abatacept 10 mg charge
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$46.56
|
| Rate for Payer: Anthem Medicare Advantage |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.56
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$69.84
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$46.56
|
| Rate for Payer: The Alliance Commercial |
$128.04
|
| Rate for Payer: United Healthcare Medicaid |
$46.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.56
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$111.38
|
|
|
Abatacept 10 mg charge
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
2958889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
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 |
$44.55 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$46.56
|
| Rate for Payer: Anthem Medicare Advantage |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.56
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$69.84
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$46.56
|
| Rate for Payer: The Alliance Commercial |
$128.04
|
| Rate for Payer: United Healthcare Medicaid |
$46.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.56
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$111.38
|
|
|
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 |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
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 |
$44.55 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$46.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.56
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$69.84
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$46.56
|
| Rate for Payer: The Alliance Commercial |
$186.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.56
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$46.56
|
| Rate for Payer: WPS Commercial |
$111.38
|
|
|
ABD dressing pad charge
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
2844895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
ABD dressing pad charge
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
2844895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
