|
Cutting 4.0mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 4.0mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 4.0mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CUTTING BUR 3MM
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Aetna Managed Medicare |
$466.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,082.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$833.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$799.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.36
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.56
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: NAPHCARE Commercial |
$999.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$1,082.95
|
| Rate for Payer: Quartz Medicare Advantage |
$999.65
|
| Rate for Payer: The Alliance Commercial |
$833.04
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
CUTTING BUR 3MM
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.38 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$999.65
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
CUTTING BUR 6.5MM
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.38 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$999.65
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
CUTTING BUR 6.5MM
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.50 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Aetna Managed Medicare |
$466.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,082.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$833.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$799.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.36
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.56
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: NAPHCARE Commercial |
$999.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$1,082.95
|
| Rate for Payer: Quartz Medicare Advantage |
$999.65
|
| Rate for Payer: The Alliance Commercial |
$833.04
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
CUTTING BURR MICA 3 X 20MM LONG 57SC320L
|
Facility
|
IP
|
$3,083.00
|
|
| Hospital Charge Code |
6192959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,571.10 |
| Max. Negotiated Rate |
$2,949.81 |
| Rate for Payer: Aetna Commercial |
$2,885.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,757.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,699.35
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,949.81
|
| Rate for Payer: Health EOS Commercial |
$2,853.62
|
| Rate for Payer: HFN Commercial |
$2,949.81
|
| Rate for Payer: Multiplan Commercial |
$2,565.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,949.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.10
|
| Rate for Payer: Quartz Commercial |
$1,923.79
|
| Rate for Payer: WEA Trust Commercial |
$1,763.48
|
| Rate for Payer: WPS Commercial |
$2,374.83
|
|
|
CUTTING BURR MICA 3 X 20MM LONG 57SC320L
|
Facility
|
OP
|
$3,083.00
|
|
| Hospital Charge Code |
6192959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.77 |
| Max. Negotiated Rate |
$2,949.81 |
| Rate for Payer: Aetna Commercial |
$2,885.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,757.44
|
| Rate for Payer: Aetna Managed Medicare |
$897.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,084.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,603.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,539.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,699.35
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,949.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,794.31
|
| Rate for Payer: Health EOS Commercial |
$2,853.62
|
| Rate for Payer: HFN Commercial |
$2,949.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,404.74
|
| Rate for Payer: Multiplan Commercial |
$2,565.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,923.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,949.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.10
|
| Rate for Payer: Quartz Commercial |
$2,084.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,923.79
|
| Rate for Payer: The Alliance Commercial |
$1,603.16
|
| Rate for Payer: WEA Trust Commercial |
$1,763.48
|
| Rate for Payer: WPS Commercial |
$2,374.83
|
|
|
CUTTING HEAD 4MM VALVULOTOME TIVH40
|
Facility
|
IP
|
$2,820.00
|
|
| Hospital Charge Code |
2973136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,437.07 |
| Max. Negotiated Rate |
$2,698.18 |
| Rate for Payer: Aetna Commercial |
$2,639.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,522.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,554.38
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,698.18
|
| Rate for Payer: Health EOS Commercial |
$2,610.19
|
| Rate for Payer: HFN Commercial |
$2,698.18
|
| Rate for Payer: Multiplan Commercial |
$2,346.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,698.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.07
|
| Rate for Payer: Quartz Commercial |
$1,759.68
|
| Rate for Payer: WEA Trust Commercial |
$1,613.04
|
| Rate for Payer: WPS Commercial |
$2,172.25
|
|
|
CUTTING HEAD 4MM VALVULOTOME TIVH40
|
Facility
|
OP
|
$2,820.00
|
|
| Hospital Charge Code |
2973136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$821.18 |
| Max. Negotiated Rate |
$2,698.18 |
| Rate for Payer: Aetna Commercial |
$2,639.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,522.21
|
| Rate for Payer: Aetna Managed Medicare |
$821.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,906.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,466.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,407.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,554.38
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,698.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,641.24
|
| Rate for Payer: Health EOS Commercial |
$2,610.19
|
| Rate for Payer: HFN Commercial |
$2,698.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,199.60
|
| Rate for Payer: Multiplan Commercial |
$2,346.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,698.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.07
|
| Rate for Payer: Quartz Commercial |
$1,906.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,759.68
|
| Rate for Payer: The Alliance Commercial |
$1,466.40
|
| Rate for Payer: WEA Trust Commercial |
$1,613.04
|
| Rate for Payer: WPS Commercial |
$2,172.25
|
|
|
Cutting OTW 2.0mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.0mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.0mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CVA AND PRECEREBRAL OCCLUSION W INFARCT
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00535
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$12,451.00
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$11,059.76 |
| Max. Negotiated Rate |
$12,451.00 |
| Rate for Payer: Anthem Medicaid |
$11,922.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,922.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,922.52
|
| Rate for Payer: Dean Health Medicaid |
$11,922.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,059.76
|
| Rate for Payer: Managed Health Services Medicaid |
$12,451.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,922.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,922.52
|
| Rate for Payer: United Healthcare Medicaid |
$11,922.52
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$20,693.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$18,381.00 |
| Max. Negotiated Rate |
$20,693.21 |
| Rate for Payer: Anthem Medicaid |
$19,814.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,814.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,814.89
|
| Rate for Payer: Dean Health Medicaid |
$19,814.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,381.00
|
| Rate for Payer: Managed Health Services Medicaid |
$20,693.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,814.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,814.89
|
| Rate for Payer: United Healthcare Medicaid |
$19,814.89
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Professional
|
Both
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,602.37 |
| Max. Negotiated Rate |
$5,618.76 |
| Rate for Payer: Aetna Commercial |
$5,618.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,618.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,957.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,548.69
|
| Rate for Payer: Health EOS Commercial |
$5,382.18
|
| Rate for Payer: HFN Commercial |
$5,618.76
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,618.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,602.37
|
| Rate for Payer: Quartz Commercial |
$3,371.25
|
| Rate for Payer: The Alliance Commercial |
$2,957.24
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Facility
|
OP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,441.32 |
| Rate for Payer: Aetna Commercial |
$5,323.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,844.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,957.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.67
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,441.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,309.83
|
| Rate for Payer: Health EOS Commercial |
$5,263.89
|
| Rate for Payer: HFN Commercial |
$5,441.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,435.86
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,548.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,441.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.10
|
| Rate for Payer: Quartz Commercial |
$3,844.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,548.69
|
| Rate for Payer: The Alliance Commercial |
$2,957.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,898.10 |
| Max. Negotiated Rate |
$5,441.32 |
| Rate for Payer: Aetna Commercial |
$5,323.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.67
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,441.32
|
| Rate for Payer: Health EOS Commercial |
$5,263.89
|
| Rate for Payer: HFN Commercial |
$5,441.32
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,441.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.10
|
| Rate for Payer: Quartz Commercial |
$3,548.69
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
