|
Core BPG Any PTCA/Stent/Athrec
|
Facility
OP
|
$27,942.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
3052466
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,596.00 |
| Max. Negotiated Rate |
$40,449.87 |
| Rate for Payer: Aetna Commercial |
$25,147.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,030.12
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,311.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,676.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,643.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,809.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$8,382.60
|
| Rate for Payer: Cash Price |
$8,382.60
|
| Rate for Payer: Cash Price |
$8,382.60
|
| Rate for Payer: Cigna Commercial |
$25,706.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$24,868.38
|
| Rate for Payer: HFN Commercial |
$25,706.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$22,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$25,706.64
|
| Rate for Payer: Quartz Beloit One Network |
$13,691.58
|
| Rate for Payer: Quartz Commercial |
$18,162.30
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$15,368.10
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$20,696.64
|
|
|
CORNEAL LACERATION
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CORNEAL LACERATION
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CORNEAL LIGHT SHIELD 581062
|
Facility
OP
|
$58.00
|
|
| Hospital Charge Code |
6172638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$16.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.46
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.50
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$37.70
|
| Rate for Payer: Quartz Medicare Advantage |
$34.80
|
| Rate for Payer: The Alliance Commercial |
$232.00
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
CORNEAL LIGHT SHIELD 581062
|
Facility
IP
|
$58.00
|
|
| Hospital Charge Code |
6172638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$34.80
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
CORNEAL PROTECTOR CROUCH DISP E5699
|
Facility
IP
|
$133.00
|
|
| Hospital Charge Code |
5385042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
CORNEAL PROTECTOR CROUCH DISP E5699
|
Facility
OP
|
$133.00
|
|
| Hospital Charge Code |
5385042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.75
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$532.00
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
CORNEAL REFRACTIVE PROCEDURE
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CORNEAL REFRACTIVE PROCEDURE
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Corneal Smear 65430
|
Professional
|
$359.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
3935373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$430.78 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$95.73
|
| Rate for Payer: Anthem Medicare Advantage |
$95.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.73
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$341.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.73
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$341.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$341.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.73
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$341.05
|
| Rate for Payer: Quartz Beloit One Network |
$157.96
|
| Rate for Payer: Quartz Commercial |
$204.63
|
| Rate for Payer: Quartz Medicare Advantage |
$95.73
|
| Rate for Payer: The Alliance Commercial |
$406.85
|
| Rate for Payer: United Healthcare Medicaid |
$24.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.73
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$430.78
|
|
|
Corneal Topography 9202526
|
Professional
|
$67.00
|
|
|
Service Code
|
CPT 92025 26
|
| Hospital Charge Code |
3455556
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.73 |
| Max. Negotiated Rate |
$74.92 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.73
|
| Rate for Payer: Anthem Medicare Advantage |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.73
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.73
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.73
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: Quartz Medicare Advantage |
$18.73
|
| Rate for Payer: The Alliance Commercial |
$46.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.73
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$74.92
|
|
|
Corneal Topography 9202550
|
Professional
|
$150.00
|
|
|
Service Code
|
CPT 92025 50
|
| Hospital Charge Code |
5368628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$142.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.00
|
| Rate for Payer: Health EOS Commercial |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$142.50
|
| Rate for Payer: Quartz Beloit One Network |
$66.00
|
| Rate for Payer: Quartz Commercial |
$85.50
|
| Rate for Payer: The Alliance Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
CORNEAL TRANSPLANT
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CORNEAL TRANSPLANT
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Corneal Ultrasound
|
Professional
|
$58.00
|
|
|
Service Code
|
CPT 76514
|
| Hospital Charge Code |
1188930
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$10.75
|
| Rate for Payer: Anthem Medicare Advantage |
$10.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.75
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.75
|
| Rate for Payer: Health EOS Commercial |
$52.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55.10
|
| Rate for Payer: Quartz Beloit One Network |
$25.52
|
| Rate for Payer: Quartz Commercial |
$33.06
|
| Rate for Payer: Quartz Medicare Advantage |
$10.75
|
| Rate for Payer: The Alliance Commercial |
$40.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.75
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$53.75
|
|
|
CORNER DRILL BIT TIBIAL 33600048
|
Facility
OP
|
$2,871.00
|
|
| Hospital Charge Code |
5831730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$803.88 |
| Max. Negotiated Rate |
$11,484.00 |
| Rate for Payer: Aetna Commercial |
$2,583.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,469.06
|
| Rate for Payer: Aetna Managed Medicare |
$803.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,866.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,435.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.63
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cigna Commercial |
$2,641.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,606.61
|
| Rate for Payer: Health EOS Commercial |
$2,555.19
|
| Rate for Payer: HFN Commercial |
$2,641.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,153.25
|
| Rate for Payer: Multiplan Commercial |
$2,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,641.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.79
|
| Rate for Payer: Quartz Commercial |
$1,866.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,722.60
|
| Rate for Payer: The Alliance Commercial |
$11,484.00
|
| Rate for Payer: WEA Trust Commercial |
$1,579.05
|
| Rate for Payer: WPS Commercial |
$2,126.55
|
|
|
CORNER DRILL BIT TIBIAL 33600048
|
Facility
IP
|
$2,871.00
|
|
| Hospital Charge Code |
5831730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.79 |
| Max. Negotiated Rate |
$2,641.32 |
| Rate for Payer: Aetna Commercial |
$2,583.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.63
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cigna Commercial |
$2,641.32
|
| Rate for Payer: Health EOS Commercial |
$2,555.19
|
| Rate for Payer: HFN Commercial |
$2,641.32
|
| Rate for Payer: Multiplan Commercial |
$2,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,641.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.79
|
| Rate for Payer: Quartz Commercial |
$1,722.60
|
| Rate for Payer: WEA Trust Commercial |
$1,579.05
|
| Rate for Payer: WPS Commercial |
$2,126.55
|
|
|
Coronaries/BPG Only
|
Facility
IP
|
$16,928.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
3052495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,294.72 |
| Max. Negotiated Rate |
$15,573.76 |
| Rate for Payer: Aetna Commercial |
$15,235.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,971.84
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cigna Commercial |
$15,573.76
|
| Rate for Payer: Health EOS Commercial |
$15,065.92
|
| Rate for Payer: HFN Commercial |
$15,573.76
|
| Rate for Payer: Multiplan Commercial |
$13,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,573.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,294.72
|
| Rate for Payer: Quartz Commercial |
$10,156.80
|
| Rate for Payer: WEA Trust Commercial |
$9,310.40
|
| Rate for Payer: WPS Commercial |
$12,538.57
|
|
|
Coronaries/BPG Only
|
Facility
OP
|
$16,928.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
3052495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$15,235.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,558.08
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,971.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cigna Commercial |
$15,573.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$15,065.92
|
| Rate for Payer: HFN Commercial |
$15,573.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$13,542.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$15,573.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,294.72
|
| Rate for Payer: Quartz Commercial |
$11,003.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$9,310.40
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$12,538.57
|
|
|
Coronaries Only
|
Facility
OP
|
$14,095.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3052494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$12,685.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,121.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,470.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cigna Commercial |
$12,967.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$12,544.55
|
| Rate for Payer: HFN Commercial |
$12,967.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$11,276.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$12,967.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,906.55
|
| Rate for Payer: Quartz Commercial |
$9,161.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$7,752.25
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$10,440.17
|
|
|
Coronaries Only
|
Facility
IP
|
$14,095.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3052494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,906.55 |
| Max. Negotiated Rate |
$12,967.40 |
| Rate for Payer: Aetna Commercial |
$12,685.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,470.35
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cigna Commercial |
$12,967.40
|
| Rate for Payer: Health EOS Commercial |
$12,544.55
|
| Rate for Payer: HFN Commercial |
$12,967.40
|
| Rate for Payer: Multiplan Commercial |
$11,276.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,457.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,967.40
|
| Rate for Payer: Quartz Beloit One Network |
$6,906.55
|
| Rate for Payer: Quartz Commercial |
$8,457.00
|
| Rate for Payer: WEA Trust Commercial |
$7,752.25
|
| Rate for Payer: WPS Commercial |
$10,440.17
|
|
|
CORONARY ARTERY BYPASS GRAFT 1 VESSEL
|
Facility
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,605.32 |
| Max. Negotiated Rate |
$80,076.00 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,216.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,605.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,012.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,009.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,609.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,202.63
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,014.25
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$13,012.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,011.40
|
| Rate for Payer: The Alliance Commercial |
$80,076.00
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
|
CORONARY ARTERY BYPASS GRAFT 1 VESSEL
|
Facility
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,809.31 |
| Max. Negotiated Rate |
$18,417.48 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$12,011.40
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
|
CORONARY ARTERY BYPASS GRAFT 2 VESSEL
|
Facility
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,809.31 |
| Max. Negotiated Rate |
$18,417.48 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$12,011.40
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
|
CORONARY ARTERY BYPASS GRAFT 2 VESSEL
|
Facility
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,605.32 |
| Max. Negotiated Rate |
$80,076.00 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,216.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,605.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,012.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,009.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,609.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,202.63
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,014.25
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$13,012.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,011.40
|
| Rate for Payer: The Alliance Commercial |
$80,076.00
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
