|
CAROTID BILATERAL 9388026
|
Professional
|
$547.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
3015428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$36.22
|
| Rate for Payer: Anthem Medicare Advantage |
$36.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.22
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$519.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.22
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.22
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$519.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.68
|
| Rate for Payer: Quartz Commercial |
$311.79
|
| Rate for Payer: Quartz Medicare Advantage |
$36.22
|
| Rate for Payer: The Alliance Commercial |
$90.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.22
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$144.88
|
|
|
CAROTID ENDARTERECTOMY/ARTERY REPAIR
|
Facility
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2959907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,204.07 |
| Max. Negotiated Rate |
$15,403.56 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,045.80
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
|
CAROTID ENDARTERECTOMY/ARTERY REPAIR
|
Facility
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2959907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,688.04 |
| Max. Negotiated Rate |
$66,972.00 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| Rate for Payer: Aetna Managed Medicare |
$4,688.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,882.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,036.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,369.38
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,557.25
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,882.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10,045.80
|
| Rate for Payer: The Alliance Commercial |
$66,972.00
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
|
Carotid Stent Intrathoracic Com/Innominate
|
Facility
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
4458575
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$537.04 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Aetna Managed Medicare |
$537.04
|
| 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 |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,438.50
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,246.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.80
|
| Rate for Payer: The Alliance Commercial |
$7,672.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carotid Stent Intrathoracic Com/Innominate
|
Facility
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 37218
|
| Hospital Charge Code |
4458575
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$939.82 |
| Max. Negotiated Rate |
$1,764.56 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,150.80
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carotid Stent W/Dist Embol Protection
|
Facility
OP
|
$15,006.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
3932028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$60,024.00 |
| Rate for Payer: Aetna Commercial |
$13,505.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,905.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,201.68
|
| 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 |
$7,953.18
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$13,805.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$13,355.34
|
| Rate for Payer: HFN Commercial |
$13,805.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,254.50
|
| Rate for Payer: Multiplan Commercial |
$12,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,003.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,805.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,352.94
|
| Rate for Payer: Quartz Commercial |
$9,753.90
|
| Rate for Payer: Quartz Medicare Advantage |
$9,003.60
|
| Rate for Payer: The Alliance Commercial |
$60,024.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$8,253.30
|
| Rate for Payer: WPS Commercial |
$11,114.94
|
|
|
Carotid Stent W/Dist Embol Protection
|
Facility
IP
|
$15,006.00
|
|
|
Service Code
|
CPT 37215
|
| Hospital Charge Code |
3932028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,352.94 |
| Max. Negotiated Rate |
$13,805.52 |
| Rate for Payer: Aetna Commercial |
$13,505.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,953.18
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$13,805.52
|
| Rate for Payer: Health EOS Commercial |
$13,355.34
|
| Rate for Payer: HFN Commercial |
$13,805.52
|
| Rate for Payer: Multiplan Commercial |
$12,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,003.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,805.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,352.94
|
| Rate for Payer: Quartz Commercial |
$9,003.60
|
| Rate for Payer: WEA Trust Commercial |
$8,253.30
|
| Rate for Payer: WPS Commercial |
$11,114.94
|
|
|
Carotid Stent W/O Dist Embol Protect
|
Facility
OP
|
$15,006.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
3932033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,201.68 |
| Max. Negotiated Rate |
$60,024.00 |
| Rate for Payer: Aetna Commercial |
$13,505.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,905.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,201.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,953.18
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$13,805.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$13,355.34
|
| Rate for Payer: HFN Commercial |
$13,805.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,254.50
|
| Rate for Payer: Multiplan Commercial |
$12,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,003.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,805.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,352.94
|
| Rate for Payer: Quartz Commercial |
$9,753.90
|
| Rate for Payer: Quartz Medicare Advantage |
$9,003.60
|
| Rate for Payer: The Alliance Commercial |
$60,024.00
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: WEA Trust Commercial |
$8,253.30
|
| Rate for Payer: WPS Commercial |
$11,114.94
|
|
|
Carotid Stent W/O Dist Embol Protect
|
Facility
IP
|
$15,006.00
|
|
|
Service Code
|
CPT 37216
|
| Hospital Charge Code |
3932033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,352.94 |
| Max. Negotiated Rate |
$13,805.52 |
| Rate for Payer: Aetna Commercial |
$13,505.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,953.18
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$13,805.52
|
| Rate for Payer: Health EOS Commercial |
$13,355.34
|
| Rate for Payer: HFN Commercial |
$13,805.52
|
| Rate for Payer: Multiplan Commercial |
$12,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,003.60
|
| Rate for Payer: Preferred Network Access Commercial |
$13,805.52
|
| Rate for Payer: Quartz Beloit One Network |
$7,352.94
|
| Rate for Payer: Quartz Commercial |
$9,003.60
|
| Rate for Payer: WEA Trust Commercial |
$8,253.30
|
| Rate for Payer: WPS Commercial |
$11,114.94
|
|
|
Carotid Unilateral 93882
|
Professional
|
$384.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
5272962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.66 |
| Max. Negotiated Rate |
$474.64 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Aetna Managed Medicare |
$118.66
|
| Rate for Payer: Anthem Medicare Advantage |
$118.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$364.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.66
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.66
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$364.80
|
| Rate for Payer: Quartz Beloit One Network |
$168.96
|
| Rate for Payer: Quartz Commercial |
$218.88
|
| Rate for Payer: Quartz Medicare Advantage |
$118.66
|
| Rate for Payer: The Alliance Commercial |
$296.65
|
| Rate for Payer: United Healthcare Medicaid |
$129.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.66
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$474.64
|
|
|
CAROTID UNILATERAL 9388226
|
Professional
|
$384.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
3015429
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Aetna Managed Medicare |
$22.20
|
| Rate for Payer: Anthem Medicare Advantage |
$22.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$364.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.20
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.20
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$364.80
|
| Rate for Payer: Quartz Beloit One Network |
$168.96
|
| Rate for Payer: Quartz Commercial |
$218.88
|
| Rate for Payer: Quartz Medicare Advantage |
$22.20
|
| Rate for Payer: The Alliance Commercial |
$55.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.20
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$88.80
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CARPAL TUNNEL RELEASE, ENDOSCOPIC
|
Facility
IP
|
$6,866.00
|
|
| Hospital Charge Code |
2960008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,364.34 |
| Max. Negotiated Rate |
$6,316.72 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,119.60
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
CARPAL TUNNEL RELEASE, ENDOSCOPIC
|
Facility
OP
|
$6,866.00
|
|
| Hospital Charge Code |
2960008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,922.48 |
| Max. Negotiated Rate |
$27,464.00 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,922.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,462.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,295.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,842.21
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,149.50
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,462.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,119.60
|
| Rate for Payer: The Alliance Commercial |
$27,464.00
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
CARPAL TUNNEL SURGERY 64721
|
Professional
|
$2,989.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
3015206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.76 |
| Max. Negotiated Rate |
$2,839.55 |
| Rate for Payer: Aetna Commercial |
$2,839.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,570.54
|
| Rate for Payer: Aetna Managed Medicare |
$412.46
|
| Rate for Payer: Anthem Medicare Advantage |
$412.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$412.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$412.46
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,839.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,494.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.46
|
| Rate for Payer: Health EOS Commercial |
$2,719.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,447.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,447.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$412.46
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,703.73
|
| Rate for Payer: Quartz Medicare Advantage |
$412.46
|
| Rate for Payer: The Alliance Commercial |
$1,752.96
|
| Rate for Payer: United Healthcare Medicaid |
$348.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$412.46
|
| Rate for Payer: WEA Trust Commercial |
$1,643.95
|
| Rate for Payer: WPS Commercial |
$1,856.07
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
OP
|
$22,318.84
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
Car Seat Challenge Testing (30 min) - Nursery Daily Charges
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
5699636
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| 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
|
|
|
Car Seat Challenge Testing (30 min) - Nursery Daily Charges
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
5699636
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.40
|
| 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: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.75
|
| 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 |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Car Seat Challenge Testing (60 min) - Nursery Daily Charges
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
5699637
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
Car Seat Challenge Testing (60 min) - Nursery Daily Charges
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
5699637
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
CARTILAGE BUR 3MM X 12MM PROSTEP MIS STERILE 58CC3012
|
Facility
OP
|
$3,758.00
|
|
| Hospital Charge Code |
6200964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.24 |
| Max. Negotiated Rate |
$15,032.00 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,231.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,052.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,442.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,879.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,803.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.98
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,818.50
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,442.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,254.80
|
| Rate for Payer: The Alliance Commercial |
$15,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
CARTILAGE BUR 3MM X 12MM PROSTEP MIS STERILE 58CC3012
|
Facility
IP
|
$3,758.00
|
|
| Hospital Charge Code |
6200964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,841.42 |
| Max. Negotiated Rate |
$3,457.36 |
| Rate for Payer: Aetna Commercial |
$3,382.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,991.74
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,457.36
|
| Rate for Payer: Health EOS Commercial |
$3,344.62
|
| Rate for Payer: HFN Commercial |
$3,457.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,254.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,457.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,841.42
|
| Rate for Payer: Quartz Commercial |
$2,254.80
|
| Rate for Payer: WEA Trust Commercial |
$2,066.90
|
| Rate for Payer: WPS Commercial |
$2,783.55
|
|
|
CARTILAGE BUR 4MM X 16MM PROSTEP MIS STERILE 58CC4016
|
Facility
OP
|
$5,414.00
|
|
| Hospital Charge Code |
6172007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,515.92 |
| Max. Negotiated Rate |
$21,656.00 |
| Rate for Payer: Aetna Commercial |
$4,872.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,656.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,515.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,519.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,707.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,598.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,869.42
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$4,980.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,029.67
|
| Rate for Payer: Health EOS Commercial |
$4,818.46
|
| Rate for Payer: HFN Commercial |
$4,980.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,060.50
|
| Rate for Payer: Multiplan Commercial |
$4,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,980.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,652.86
|
| Rate for Payer: Quartz Commercial |
$3,519.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,248.40
|
| Rate for Payer: The Alliance Commercial |
$21,656.00
|
| Rate for Payer: WEA Trust Commercial |
$2,977.70
|
| Rate for Payer: WPS Commercial |
$4,010.15
|
|
|
CARTILAGE BUR 4MM X 16MM PROSTEP MIS STERILE 58CC4016
|
Facility
IP
|
$5,414.00
|
|
| Hospital Charge Code |
6172007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,652.86 |
| Max. Negotiated Rate |
$4,980.88 |
| Rate for Payer: Aetna Commercial |
$4,872.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,869.42
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$4,980.88
|
| Rate for Payer: Health EOS Commercial |
$4,818.46
|
| Rate for Payer: HFN Commercial |
$4,980.88
|
| Rate for Payer: Multiplan Commercial |
$4,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,980.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,652.86
|
| Rate for Payer: Quartz Commercial |
$3,248.40
|
| Rate for Payer: WEA Trust Commercial |
$2,977.70
|
| Rate for Payer: WPS Commercial |
$4,010.15
|
|
