|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$61,455.00
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$22,106.05 |
| Max. Negotiated Rate |
$61,455.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,106.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,254.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,986.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,139.40
|
| Rate for Payer: Anthem Medicare Advantage |
$22,106.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,106.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,106.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,106.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,007.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,106.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,840.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,106.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,106.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,106.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,106.05
|
| Rate for Payer: NAPHCARE Commercial |
$33,159.08
|
| Rate for Payer: Quartz Medicare Advantage |
$22,106.05
|
| Rate for Payer: The Alliance Commercial |
$61,455.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,106.05
|
| Rate for Payer: United Healthcare PPO |
$34,908.71
|
| Rate for Payer: Wellcare Medicare |
$22,106.05
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$104,043.00
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$37,425.50 |
| Max. Negotiated Rate |
$104,043.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,425.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,822.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,715.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,584.20
|
| Rate for Payer: Anthem Medicare Advantage |
$37,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,425.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,425.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,425.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66,143.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,425.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76,077.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,425.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,425.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,425.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,425.50
|
| Rate for Payer: NAPHCARE Commercial |
$56,138.25
|
| Rate for Payer: Quartz Medicare Advantage |
$37,425.50
|
| Rate for Payer: The Alliance Commercial |
$104,043.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,425.50
|
| Rate for Payer: United Healthcare PPO |
$59,227.15
|
| Rate for Payer: Wellcare Medicare |
$37,425.50
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,393.00
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$17,407.61 |
| Max. Negotiated Rate |
$48,393.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,407.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,973.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,106.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,653.18
|
| Rate for Payer: Anthem Medicare Advantage |
$17,407.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,407.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,407.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,407.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,697.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,407.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,259.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,407.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,407.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,407.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,407.61
|
| Rate for Payer: NAPHCARE Commercial |
$26,111.42
|
| Rate for Payer: Quartz Medicare Advantage |
$17,407.61
|
| Rate for Payer: The Alliance Commercial |
$48,393.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,407.61
|
| Rate for Payer: United Healthcare PPO |
$27,450.28
|
| Rate for Payer: Wellcare Medicare |
$17,407.61
|
|
|
Carotid Bilateral 93880
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
5272960
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.09 |
| Max. Negotiated Rate |
$678.11 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| 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 |
$166.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.20
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: HFN Commercial |
$519.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$678.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$678.11
|
| 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: The Alliance Commercial |
$273.50
|
| Rate for Payer: United Healthcare Medicaid |
$166.09
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
CAROTID BILATERAL 9388026
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
3015428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.89 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| 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 |
$328.20
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: HFN Commercial |
$519.65
|
| 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: 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: The Alliance Commercial |
$273.50
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| 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 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 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: Aetna Gatekeeper/Not Gatekeeper |
$12,905.16
|
| 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/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/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: Aetna Gatekeeper/Not Gatekeeper |
$12,905.16
|
| 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
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
5272962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$439.27 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| 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 |
$129.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.40
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: HFN Commercial |
$364.80
|
| 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: 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: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.34
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
CAROTID UNILATERAL 9388226
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
3015429
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.19 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| 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 |
$230.40
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: HFN Commercial |
$364.80
|
| 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: 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: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| 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, 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: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| 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
|
Both
|
$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: 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 |
$348.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,793.40
|
| Rate for Payer: Health EOS Commercial |
$2,719.99
|
| Rate for Payer: HFN Commercial |
$2,839.55
|
| 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: 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: The Alliance Commercial |
$1,494.50
|
| Rate for Payer: United Healthcare Medicaid |
$348.76
|
| Rate for Payer: WEA Trust Commercial |
$1,643.95
|
| Rate for Payer: WPS Commercial |
$2,213.95
|
|
|
CARPECTOMY; ALL BONES OF PROXIMAL ROW
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| 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 |
$12,797.24
|
| 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
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
5699636
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$420.00 |
| 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: The Alliance Commercial |
$420.00
|
| 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
|
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: 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| 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: The Alliance Commercial |
$158.56
|
| 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
|
|
