|
Cor Athrec W/Stent & PTCA add Branch +
|
Facility
|
IP
|
$3,112.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
4125716
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,585.88 |
| Max. Negotiated Rate |
$2,977.56 |
| Rate for Payer: Aetna Commercial |
$2,912.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,783.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,715.33
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$2,977.56
|
| Rate for Payer: Health EOS Commercial |
$2,880.47
|
| Rate for Payer: HFN Commercial |
$2,977.56
|
| Rate for Payer: Multiplan Commercial |
$2,589.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,977.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.88
|
| Rate for Payer: Quartz Commercial |
$1,941.89
|
| Rate for Payer: WEA Trust Commercial |
$1,780.06
|
| Rate for Payer: WPS Commercial |
$2,397.17
|
|
|
Cor Athrec W/Stent & PTCA add Branch +
|
Facility
|
OP
|
$3,112.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
4125716
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$906.21 |
| Max. Negotiated Rate |
$24,243.44 |
| Rate for Payer: Aetna Commercial |
$2,912.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,783.37
|
| Rate for Payer: Aetna Managed Medicare |
$906.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,715.33
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cigna Commercial |
$2,977.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,880.47
|
| Rate for Payer: HFN Commercial |
$2,977.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,427.36
|
| Rate for Payer: Multiplan Commercial |
$2,589.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,977.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.88
|
| Rate for Payer: Quartz Commercial |
$2,103.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,941.89
|
| Rate for Payer: The Alliance Commercial |
$1,618.24
|
| Rate for Payer: WEA Trust Commercial |
$1,780.06
|
| Rate for Payer: WPS Commercial |
$2,397.17
|
|
|
Cor BPG Any PTCA/Stent/Athrec Add Branch +
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
3052467
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
Cor BPG Any PTCA/Stent/Athrec Add Branch +
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
3052467
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$431.27 |
| Max. Negotiated Rate |
$24,243.44 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$431.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.18
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$924.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$1,001.16
|
| Rate for Payer: Quartz Medicare Advantage |
$924.14
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
COR CTO STENT/ATHREC/PTCA
|
Facility
|
IP
|
$26,746.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
3052521
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13,629.76 |
| Max. Negotiated Rate |
$25,590.57 |
| Rate for Payer: Aetna Commercial |
$25,034.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,921.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,742.40
|
| Rate for Payer: Cash Price |
$8,023.80
|
| Rate for Payer: Cigna Commercial |
$25,590.57
|
| Rate for Payer: Health EOS Commercial |
$24,756.10
|
| Rate for Payer: HFN Commercial |
$25,590.57
|
| Rate for Payer: Multiplan Commercial |
$22,252.67
|
| Rate for Payer: Preferred Network Access Commercial |
$25,590.57
|
| Rate for Payer: Quartz Beloit One Network |
$13,629.76
|
| Rate for Payer: Quartz Commercial |
$16,689.50
|
| Rate for Payer: WEA Trust Commercial |
$15,298.71
|
| Rate for Payer: WPS Commercial |
$20,602.44
|
|
|
COR CTO STENT/ATHREC/PTCA
|
Facility
|
OP
|
$26,746.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
3052521
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,148.98 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$25,034.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,921.62
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,742.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cash Price |
$8,023.80
|
| Rate for Payer: Cash Price |
$8,023.80
|
| Rate for Payer: Cash Price |
$8,023.80
|
| Rate for Payer: Cigna Commercial |
$25,590.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$24,756.10
|
| Rate for Payer: HFN Commercial |
$25,590.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$22,252.67
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$25,590.57
|
| Rate for Payer: Quartz Beloit One Network |
$13,629.76
|
| Rate for Payer: Quartz Commercial |
$18,080.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$20,861.88
|
| Rate for Payer: WEA Trust Commercial |
$15,298.71
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$20,602.44
|
|
|
Cor CTO Stent/Athrec/PTCA Brch/BPG +
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
3052522
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$413.80 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna Commercial |
$760.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.57
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$776.92
|
| Rate for Payer: Health EOS Commercial |
$751.59
|
| Rate for Payer: HFN Commercial |
$776.92
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: Preferred Network Access Commercial |
$776.92
|
| Rate for Payer: Quartz Beloit One Network |
$413.80
|
| Rate for Payer: Quartz Commercial |
$506.69
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: WPS Commercial |
$625.48
|
|
|
Cor CTO Stent/Athrec/PTCA Brch/BPG +
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
3052522
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$236.45 |
| Max. Negotiated Rate |
$24,243.44 |
| Rate for Payer: Aetna Commercial |
$760.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Aetna Managed Medicare |
$236.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$447.57
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$776.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$751.59
|
| Rate for Payer: HFN Commercial |
$776.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$633.36
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: NAPHCARE Commercial |
$506.69
|
| Rate for Payer: Preferred Network Access Commercial |
$776.92
|
| Rate for Payer: Quartz Beloit One Network |
$413.80
|
| Rate for Payer: Quartz Commercial |
$548.91
|
| Rate for Payer: Quartz Medicare Advantage |
$506.69
|
| Rate for Payer: The Alliance Commercial |
$422.24
|
| Rate for Payer: United Healthcare PPO |
$633.36
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: WPS Commercial |
$625.48
|
|
|
CORD FOOTSWITCH BIPOLAR CORD E0509/E0512
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
2963077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
CORD FOOTSWITCH BIPOLAR CORD E0509/E0512
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
2963077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Core BPG Any PTCA/Stent/Athrec
|
Facility
|
IP
|
$27,942.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
3052466
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14,239.24 |
| Max. Negotiated Rate |
$26,734.91 |
| Rate for Payer: Aetna Commercial |
$26,153.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,991.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,401.63
|
| Rate for Payer: Cash Price |
$8,382.60
|
| Rate for Payer: Cigna Commercial |
$26,734.91
|
| Rate for Payer: Health EOS Commercial |
$25,863.12
|
| Rate for Payer: HFN Commercial |
$26,734.91
|
| Rate for Payer: Multiplan Commercial |
$23,247.74
|
| Rate for Payer: Preferred Network Access Commercial |
$26,734.91
|
| Rate for Payer: Quartz Beloit One Network |
$14,239.24
|
| Rate for Payer: Quartz Commercial |
$17,435.81
|
| Rate for Payer: WEA Trust Commercial |
$15,982.82
|
| Rate for Payer: WPS Commercial |
$21,523.72
|
|
|
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 |
$9,979.84 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$26,153.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,991.32
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,401.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| 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 |
$26,734.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$25,863.12
|
| Rate for Payer: HFN Commercial |
$26,734.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$23,247.74
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26,734.91
|
| Rate for Payer: Quartz Beloit One Network |
$14,239.24
|
| Rate for Payer: Quartz Commercial |
$18,888.79
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$15,982.82
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$21,523.72
|
|
|
CORNEAL LACERATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CORNEAL LACERATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CORNEAL LIGHT SHIELD 581062
|
Facility
|
IP
|
$58.00
|
|
| Hospital Charge Code |
6172638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$36.19
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
CORNEAL LIGHT SHIELD 581062
|
Facility
|
OP
|
$58.00
|
|
| Hospital Charge Code |
6172638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.76
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.24
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$36.19
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$39.21
|
| Rate for Payer: Quartz Medicare Advantage |
$36.19
|
| Rate for Payer: The Alliance Commercial |
$30.16
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
CORNEAL PROTECTOR CROUCH DISP E5699
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
5385042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
CORNEAL PROTECTOR CROUCH DISP E5699
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
5385042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.74
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$82.99
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$82.99
|
| Rate for Payer: The Alliance Commercial |
$69.16
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
CORNEAL REFRACTIVE PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CORNEAL REFRACTIVE PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Corneal Smear 65430
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
3935373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$381.56 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$84.79
|
| Rate for Payer: Anthem Medicare Advantage |
$84.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.79
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.79
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.79
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$127.19
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$84.79
|
| Rate for Payer: The Alliance Commercial |
$360.36
|
| Rate for Payer: United Healthcare Medicaid |
$25.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.79
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$381.56
|
|
|
CORNEAL TISSUE PROCESSING
|
Facility
|
OP
|
$552.95
|
|
|
Service Code
|
EAPG 00485
|
| Min. Negotiated Rate |
$531.68 |
| Max. Negotiated Rate |
$552.95 |
| Rate for Payer: Anthem Medicaid |
$531.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$531.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.68
|
| Rate for Payer: Dean Health Medicaid |
$531.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$531.68
|
| Rate for Payer: Managed Health Services Medicaid |
$552.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$531.68
|
| Rate for Payer: United Healthcare Medicaid |
$531.68
|
|
|
Corneal Topography 9202526
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 92025 26
|
| Hospital Charge Code |
3455556
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$78.29 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.57
|
| Rate for Payer: Anthem Medicare Advantage |
$19.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.57
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.57
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.57
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$29.36
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$19.57
|
| Rate for Payer: The Alliance Commercial |
$48.93
|
| Rate for Payer: United Healthcare Medicaid |
$14.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.57
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$78.29
|
|
|
Corneal Topography 9202550
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 92025 50
|
| Hospital Charge Code |
5368628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.60
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.07
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.88
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
CORNEAL TRANSPLANT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
