|
CAROTID BILATERAL 9388026
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 93880 26
|
| Hospital Charge Code |
3015428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$36.83
|
| Rate for Payer: Anthem Medicare Advantage |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.83
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.83
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.83
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$55.24
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$36.83
|
| Rate for Payer: The Alliance Commercial |
$92.07
|
| Rate for Payer: United Healthcare Medicaid |
$30.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.83
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$147.31
|
|
|
CAROTID ENDARTERECTOMY/ARTERY REPAIR
|
Facility
|
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2959907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,875.56 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Aetna Managed Medicare |
$4,875.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,318.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,706.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,358.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,744.43
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,059.54
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: NAPHCARE Commercial |
$10,447.63
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$11,318.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10,447.63
|
| Rate for Payer: The Alliance Commercial |
$8,706.36
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
CAROTID ENDARTERECTOMY/ARTERY REPAIR
|
Facility
|
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2959907
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,532.23 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$10,447.63
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
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 |
$977.41 |
| Max. Negotiated Rate |
$1,835.14 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,196.83
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
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 |
$558.52 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$558.52
|
| 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 |
$1,057.20
|
| 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 |
$1,835.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,496.04
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,296.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.83
|
| Rate for Payer: The Alliance Commercial |
$2,717.02
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
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 |
$3,228.53 |
| Max. Negotiated Rate |
$14,357.74 |
| Rate for Payer: Aetna Commercial |
$14,045.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,421.37
|
| Rate for Payer: Aetna Managed Medicare |
$4,369.75
|
| 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 |
$8,271.31
|
| 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 |
$14,357.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$13,889.55
|
| Rate for Payer: HFN Commercial |
$14,357.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,704.68
|
| Rate for Payer: Multiplan Commercial |
$12,484.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,363.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,357.74
|
| Rate for Payer: Quartz Beloit One Network |
$7,647.06
|
| Rate for Payer: Quartz Commercial |
$10,144.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,363.74
|
| Rate for Payer: The Alliance Commercial |
$3,228.53
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$8,583.43
|
| Rate for Payer: WPS Commercial |
$11,559.12
|
|
|
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 |
$7,647.06 |
| Max. Negotiated Rate |
$14,357.74 |
| Rate for Payer: Aetna Commercial |
$14,045.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,421.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,271.31
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$14,357.74
|
| Rate for Payer: Health EOS Commercial |
$13,889.55
|
| Rate for Payer: HFN Commercial |
$14,357.74
|
| Rate for Payer: Multiplan Commercial |
$12,484.99
|
| Rate for Payer: Preferred Network Access Commercial |
$14,357.74
|
| Rate for Payer: Quartz Beloit One Network |
$7,647.06
|
| Rate for Payer: Quartz Commercial |
$9,363.74
|
| Rate for Payer: WEA Trust Commercial |
$8,583.43
|
| Rate for Payer: WPS Commercial |
$11,559.12
|
|
|
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 |
$4,369.75 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Aetna Commercial |
$14,045.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,421.37
|
| Rate for Payer: Aetna Managed Medicare |
$4,369.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,271.31
|
| 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 |
$14,357.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$13,889.55
|
| Rate for Payer: HFN Commercial |
$14,357.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,704.68
|
| Rate for Payer: Multiplan Commercial |
$12,484.99
|
| Rate for Payer: NAPHCARE Commercial |
$9,363.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,357.74
|
| Rate for Payer: Quartz Beloit One Network |
$7,647.06
|
| Rate for Payer: Quartz Commercial |
$10,144.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,363.74
|
| Rate for Payer: The Alliance Commercial |
$7,803.12
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: WEA Trust Commercial |
$8,583.43
|
| Rate for Payer: WPS Commercial |
$11,559.12
|
|
|
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 |
$7,647.06 |
| Max. Negotiated Rate |
$14,357.74 |
| Rate for Payer: Aetna Commercial |
$14,045.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,421.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,271.31
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna Commercial |
$14,357.74
|
| Rate for Payer: Health EOS Commercial |
$13,889.55
|
| Rate for Payer: HFN Commercial |
$14,357.74
|
| Rate for Payer: Multiplan Commercial |
$12,484.99
|
| Rate for Payer: Preferred Network Access Commercial |
$14,357.74
|
| Rate for Payer: Quartz Beloit One Network |
$7,647.06
|
| Rate for Payer: Quartz Commercial |
$9,363.74
|
| Rate for Payer: WEA Trust Commercial |
$8,583.43
|
| Rate for Payer: WPS Commercial |
$11,559.12
|
|
|
Carotid Unilateral 93882
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
5272962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.37 |
| Max. Negotiated Rate |
$489.47 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$122.37
|
| Rate for Payer: Anthem Medicare Advantage |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.37
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.37
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.37
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$183.55
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: Quartz Medicare Advantage |
$122.37
|
| Rate for Payer: The Alliance Commercial |
$305.92
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.37
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$489.47
|
|
|
CAROTID UNILATERAL 9388226
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 93882 26
|
| Hospital Charge Code |
3015429
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$22.65
|
| Rate for Payer: Anthem Medicare Advantage |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.65
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.65
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.65
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$33.98
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: Quartz Medicare Advantage |
$22.65
|
| Rate for Payer: The Alliance Commercial |
$56.63
|
| Rate for Payer: United Healthcare Medicaid |
$22.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.65
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$90.60
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959908
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
CARPAL TUNNEL RELEASE, ENDOSCOPIC
|
Facility
|
OP
|
$6,866.00
|
|
| Hospital Charge Code |
2960008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,999.38 |
| Max. Negotiated Rate |
$6,569.39 |
| Rate for Payer: Aetna Commercial |
$6,426.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,140.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,999.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,641.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,570.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,427.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,784.54
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,569.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,996.01
|
| Rate for Payer: Health EOS Commercial |
$6,355.17
|
| Rate for Payer: HFN Commercial |
$6,569.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,355.48
|
| Rate for Payer: Multiplan Commercial |
$5,712.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,284.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,569.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,498.91
|
| Rate for Payer: Quartz Commercial |
$4,641.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,284.38
|
| Rate for Payer: The Alliance Commercial |
$3,570.32
|
| Rate for Payer: WEA Trust Commercial |
$3,927.35
|
| Rate for Payer: WPS Commercial |
$5,288.88
|
|
|
CARPAL TUNNEL RELEASE, ENDOSCOPIC
|
Facility
|
IP
|
$6,866.00
|
|
| Hospital Charge Code |
2960008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,498.91 |
| Max. Negotiated Rate |
$6,569.39 |
| Rate for Payer: Aetna Commercial |
$6,426.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,140.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,784.54
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,569.39
|
| Rate for Payer: Health EOS Commercial |
$6,355.17
|
| Rate for Payer: HFN Commercial |
$6,569.39
|
| Rate for Payer: Multiplan Commercial |
$5,712.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,569.39
|
| Rate for Payer: Quartz Beloit One Network |
$3,498.91
|
| Rate for Payer: Quartz Commercial |
$4,284.38
|
| Rate for Payer: WEA Trust Commercial |
$3,927.35
|
| Rate for Payer: WPS Commercial |
$5,288.88
|
|
|
CARPAL TUNNEL SURGERY 64721
|
Professional
|
Both
|
$2,989.00
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
3015206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$362.71 |
| Max. Negotiated Rate |
$2,953.13 |
| Rate for Payer: Aetna Commercial |
$2,953.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,673.36
|
| Rate for Payer: Aetna Managed Medicare |
$406.36
|
| Rate for Payer: Anthem Medicare Advantage |
$406.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$406.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$406.36
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,953.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.36
|
| Rate for Payer: Health EOS Commercial |
$2,828.79
|
| Rate for Payer: HFN Commercial |
$2,953.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,505.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,505.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$406.36
|
| Rate for Payer: Multiplan Commercial |
$2,486.85
|
| Rate for Payer: NAPHCARE Commercial |
$609.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,953.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,771.88
|
| Rate for Payer: Quartz Medicare Advantage |
$406.36
|
| Rate for Payer: The Alliance Commercial |
$1,727.03
|
| Rate for Payer: United Healthcare Medicaid |
$362.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$406.36
|
| Rate for Payer: WEA Trust Commercial |
$1,709.71
|
| Rate for Payer: WPS Commercial |
$1,828.62
|
|
|
Carpectomy; all bones of proximal row
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| 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: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
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 |
$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
|
|
|
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 |
$28.04 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$30.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$65.52
|
| 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 |
$65.52
|
| Rate for Payer: The Alliance Commercial |
$28.04
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
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 |
$39.31 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
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 |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
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 |
$1,094.33 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,540.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,954.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,875.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.16
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,931.24
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,344.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,540.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,344.99
|
| Rate for Payer: The Alliance Commercial |
$1,954.16
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
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 |
$1,915.08 |
| Max. Negotiated Rate |
$3,595.65 |
| Rate for Payer: Aetna Commercial |
$3,517.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,361.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,071.41
|
| Rate for Payer: Cash Price |
$1,127.40
|
| Rate for Payer: Cigna Commercial |
$3,595.65
|
| Rate for Payer: Health EOS Commercial |
$3,478.40
|
| Rate for Payer: HFN Commercial |
$3,595.65
|
| Rate for Payer: Multiplan Commercial |
$3,126.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,595.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.08
|
| Rate for Payer: Quartz Commercial |
$2,344.99
|
| Rate for Payer: WEA Trust Commercial |
$2,149.58
|
| Rate for Payer: WPS Commercial |
$2,894.79
|
|
|
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 |
$1,576.56 |
| Max. Negotiated Rate |
$5,180.12 |
| Rate for Payer: Aetna Commercial |
$5,067.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,842.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,576.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,659.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,815.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,702.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,984.20
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$5,180.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,150.95
|
| Rate for Payer: Health EOS Commercial |
$5,011.20
|
| Rate for Payer: HFN Commercial |
$5,180.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,222.92
|
| Rate for Payer: Multiplan Commercial |
$4,504.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,378.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,180.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.97
|
| Rate for Payer: Quartz Commercial |
$3,659.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,378.34
|
| Rate for Payer: The Alliance Commercial |
$2,815.28
|
| Rate for Payer: WEA Trust Commercial |
$3,096.81
|
| Rate for Payer: WPS Commercial |
$4,170.40
|
|
|
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 |
$2,758.97 |
| Max. Negotiated Rate |
$5,180.12 |
| Rate for Payer: Aetna Commercial |
$5,067.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,842.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,984.20
|
| Rate for Payer: Cash Price |
$1,624.20
|
| Rate for Payer: Cigna Commercial |
$5,180.12
|
| Rate for Payer: Health EOS Commercial |
$5,011.20
|
| Rate for Payer: HFN Commercial |
$5,180.12
|
| Rate for Payer: Multiplan Commercial |
$4,504.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,180.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.97
|
| Rate for Payer: Quartz Commercial |
$3,378.34
|
| Rate for Payer: WEA Trust Commercial |
$3,096.81
|
| Rate for Payer: WPS Commercial |
$4,170.40
|
|
