|
DUPLEX SCAN HEMO COMPL BI STUDY 93985
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
5565293
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.33 |
| Max. Negotiated Rate |
$982.22 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Aetna Managed Medicare |
$245.55
|
| Rate for Payer: Anthem Medicare Advantage |
$245.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.55
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$225.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.55
|
| Rate for Payer: Health EOS Commercial |
$215.78
|
| Rate for Payer: HFN Commercial |
$225.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$939.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.55
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$368.33
|
| Rate for Payer: Preferred Network Access Commercial |
$225.26
|
| Rate for Payer: Quartz Beloit One Network |
$104.33
|
| Rate for Payer: Quartz Commercial |
$135.16
|
| Rate for Payer: Quartz Medicare Advantage |
$245.55
|
| Rate for Payer: The Alliance Commercial |
$613.89
|
| Rate for Payer: United Healthcare Medicaid |
$213.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.55
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$982.22
|
|
|
DUPLEX SCAN HEMO COMPL BI STUDY 9398526
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 93985 26
|
| Hospital Charge Code |
5586204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Aetna Managed Medicare |
$35.37
|
| Rate for Payer: Anthem Medicare Advantage |
$35.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.37
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$225.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.37
|
| Rate for Payer: Health EOS Commercial |
$215.78
|
| Rate for Payer: HFN Commercial |
$225.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.37
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$53.06
|
| Rate for Payer: Preferred Network Access Commercial |
$225.26
|
| Rate for Payer: Quartz Beloit One Network |
$104.33
|
| Rate for Payer: Quartz Commercial |
$135.16
|
| Rate for Payer: Quartz Medicare Advantage |
$35.37
|
| Rate for Payer: The Alliance Commercial |
$88.43
|
| Rate for Payer: United Healthcare Medicaid |
$30.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.37
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$141.48
|
|
|
Duplex scan hemo compl uni study
|
Facility
|
IP
|
$1,503.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5595414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$765.93 |
| Max. Negotiated Rate |
$1,438.07 |
| Rate for Payer: Aetna Commercial |
$1,406.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,344.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.45
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,438.07
|
| Rate for Payer: Health EOS Commercial |
$1,391.18
|
| Rate for Payer: HFN Commercial |
$1,438.07
|
| Rate for Payer: Multiplan Commercial |
$1,250.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.07
|
| Rate for Payer: Quartz Beloit One Network |
$765.93
|
| Rate for Payer: Quartz Commercial |
$937.87
|
| Rate for Payer: WEA Trust Commercial |
$859.72
|
| Rate for Payer: WPS Commercial |
$1,157.76
|
|
|
Duplex scan hemo compl uni study
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5595414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,438.07 |
| Rate for Payer: Aetna Commercial |
$1,406.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,344.28
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,016.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$781.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$750.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$828.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,438.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$874.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,391.18
|
| Rate for Payer: HFN Commercial |
$1,438.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,250.50
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,438.07
|
| Rate for Payer: Quartz Beloit One Network |
$765.93
|
| Rate for Payer: Quartz Commercial |
$1,016.03
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$859.72
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,157.76
|
|
|
DUPLEX SCAN HEMO COMPL UNI STUDY 93986
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5565307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$584.85 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$146.21
|
| Rate for Payer: Anthem Medicare Advantage |
$146.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.21
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.21
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.21
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$219.32
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$146.21
|
| Rate for Payer: The Alliance Commercial |
$365.53
|
| Rate for Payer: United Healthcare Medicaid |
$123.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.21
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$584.85
|
|
|
DUPLEX SCAN HEMO COMPL UNI STUDY 9398626
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 93986 26
|
| Hospital Charge Code |
5586205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$22.10
|
| Rate for Payer: Anthem Medicare Advantage |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.10
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.10
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.10
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$33.15
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$22.10
|
| Rate for Payer: The Alliance Commercial |
$55.25
|
| Rate for Payer: United Healthcare Medicaid |
$19.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.10
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$88.40
|
|
|
DUPUYTREN'S CONTRACTURE RELEASE
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
DUPUYTREN'S CONTRACTURE RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
Durysta 10 mcg J7351
|
Facility
|
IP
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,402.76 |
| Max. Negotiated Rate |
$4,511.31 |
| Rate for Payer: Aetna Commercial |
$4,413.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,217.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.91
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,511.31
|
| Rate for Payer: Health EOS Commercial |
$4,364.20
|
| Rate for Payer: HFN Commercial |
$4,511.31
|
| Rate for Payer: Multiplan Commercial |
$3,922.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,511.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.76
|
| Rate for Payer: Quartz Commercial |
$2,942.16
|
| Rate for Payer: WEA Trust Commercial |
$2,696.98
|
| Rate for Payer: WPS Commercial |
$3,631.96
|
|
|
Durysta 10 mcg J7351
|
Facility
|
OP
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$222.31 |
| Max. Negotiated Rate |
$4,511.31 |
| Rate for Payer: Aetna Commercial |
$4,413.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,217.10
|
| Rate for Payer: Aetna Managed Medicare |
$222.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,187.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,451.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,353.73
|
| Rate for Payer: Anthem Medicare Advantage |
$222.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$222.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$222.31
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,511.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$222.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$222.31
|
| Rate for Payer: Health EOS Commercial |
$4,364.20
|
| Rate for Payer: HFN Commercial |
$4,511.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$222.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$222.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$222.31
|
| Rate for Payer: Multiplan Commercial |
$3,922.88
|
| Rate for Payer: NAPHCARE Commercial |
$333.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,511.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.76
|
| Rate for Payer: Quartz Commercial |
$3,187.34
|
| Rate for Payer: Quartz Medicare Advantage |
$222.31
|
| Rate for Payer: The Alliance Commercial |
$889.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.31
|
| Rate for Payer: WEA Trust Commercial |
$2,696.98
|
| Rate for Payer: Wellcare Medicare |
$222.31
|
| Rate for Payer: WPS Commercial |
$536.10
|
|
|
Durysta 10 mcg J7351
|
Professional
|
Both
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.44 |
| Max. Negotiated Rate |
$4,658.42 |
| Rate for Payer: Aetna Commercial |
$4,658.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,217.10
|
| Rate for Payer: Aetna Managed Medicare |
$222.31
|
| Rate for Payer: Anthem Medicare Advantage |
$222.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$222.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$222.31
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,658.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.44
|
| Rate for Payer: Health EOS Commercial |
$4,462.28
|
| Rate for Payer: HFN Commercial |
$4,658.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$313.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$313.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$222.31
|
| Rate for Payer: Multiplan Commercial |
$3,922.88
|
| Rate for Payer: NAPHCARE Commercial |
$333.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,658.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.58
|
| Rate for Payer: Quartz Commercial |
$2,795.05
|
| Rate for Payer: Quartz Medicare Advantage |
$222.31
|
| Rate for Payer: The Alliance Commercial |
$611.35
|
| Rate for Payer: United Healthcare Medicaid |
$222.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.31
|
| Rate for Payer: WEA Trust Commercial |
$2,696.98
|
| Rate for Payer: WPS Commercial |
$536.10
|
|
|
DVT-bilateral 93970
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
3015440
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$729.29 |
| Rate for Payer: Aetna Commercial |
$422.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.80
|
| Rate for Payer: Aetna Managed Medicare |
$182.32
|
| Rate for Payer: Anthem Medicare Advantage |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$182.32
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$422.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.32
|
| Rate for Payer: Health EOS Commercial |
$405.06
|
| Rate for Payer: HFN Commercial |
$422.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$182.32
|
| Rate for Payer: Multiplan Commercial |
$356.10
|
| Rate for Payer: NAPHCARE Commercial |
$273.48
|
| Rate for Payer: Preferred Network Access Commercial |
$422.86
|
| Rate for Payer: Quartz Beloit One Network |
$195.85
|
| Rate for Payer: Quartz Commercial |
$253.72
|
| Rate for Payer: Quartz Medicare Advantage |
$182.32
|
| Rate for Payer: The Alliance Commercial |
$455.81
|
| Rate for Payer: United Healthcare Medicaid |
$175.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.32
|
| Rate for Payer: WEA Trust Commercial |
$244.82
|
| Rate for Payer: WPS Commercial |
$729.29
|
|
|
DVT UNILATERAL 93971
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
3015445
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$461.26 |
| Rate for Payer: Aetna Commercial |
$323.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$115.32
|
| Rate for Payer: Anthem Medicare Advantage |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.32
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$323.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.32
|
| Rate for Payer: Health EOS Commercial |
$309.47
|
| Rate for Payer: HFN Commercial |
$323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$434.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.32
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$172.97
|
| Rate for Payer: Preferred Network Access Commercial |
$323.08
|
| Rate for Payer: Quartz Beloit One Network |
$149.64
|
| Rate for Payer: Quartz Commercial |
$193.85
|
| Rate for Payer: Quartz Medicare Advantage |
$115.32
|
| Rate for Payer: The Alliance Commercial |
$288.29
|
| Rate for Payer: United Healthcare Medicaid |
$113.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.32
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$461.26
|
|
|
DVT UNILATERAL 9397126
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 93971 26
|
| Hospital Charge Code |
3015447
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Commercial |
$323.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$20.26
|
| Rate for Payer: Anthem Medicare Advantage |
$20.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.26
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$323.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.26
|
| Rate for Payer: Health EOS Commercial |
$309.47
|
| Rate for Payer: HFN Commercial |
$323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.26
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$30.39
|
| Rate for Payer: Preferred Network Access Commercial |
$323.08
|
| Rate for Payer: Quartz Beloit One Network |
$149.64
|
| Rate for Payer: Quartz Commercial |
$193.85
|
| Rate for Payer: Quartz Medicare Advantage |
$20.26
|
| Rate for Payer: The Alliance Commercial |
$50.65
|
| Rate for Payer: United Healthcare Medicaid |
$22.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.26
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$81.04
|
|
|
DXA Bone Denisity, Axial 77080
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
3243523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$195.52 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$39.10
|
| Rate for Payer: Anthem Medicare Advantage |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.10
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.10
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: Quartz Medicare Advantage |
$39.10
|
| Rate for Payer: The Alliance Commercial |
$148.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.10
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$195.52
|
|
|
DXA Bone Density, Axial 7708026
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 77080 26
|
| Hospital Charge Code |
3242174
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$35.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$46.90
|
|
|
DXA Bone Density/Peripheral 7708126
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 77081 26
|
| Hospital Charge Code |
3358866
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$35.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$46.90
|
|
|
DX BRONCHOSCOPE/BRUSH 31623
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
5619672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.11 |
| Max. Negotiated Rate |
$1,783.34 |
| Rate for Payer: Aetna Commercial |
$1,783.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$117.11
|
| Rate for Payer: Anthem Medicare Advantage |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117.11
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,783.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.11
|
| Rate for Payer: Health EOS Commercial |
$1,708.25
|
| Rate for Payer: HFN Commercial |
$1,783.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$466.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117.11
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$175.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.34
|
| Rate for Payer: Quartz Beloit One Network |
$825.97
|
| Rate for Payer: Quartz Commercial |
$1,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$117.11
|
| Rate for Payer: The Alliance Commercial |
$497.74
|
| Rate for Payer: United Healthcare Medicaid |
$215.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.11
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$527.01
|
|
|
DX BRONCHOSCOPE/LAVAGE 31624
|
Professional
|
Both
|
$1,877.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
3014399
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.78 |
| Max. Negotiated Rate |
$1,854.48 |
| Rate for Payer: Aetna Commercial |
$1,854.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,678.79
|
| Rate for Payer: Aetna Managed Medicare |
$118.78
|
| Rate for Payer: Anthem Medicare Advantage |
$118.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.78
|
| Rate for Payer: Cash Price |
$563.10
|
| Rate for Payer: Cash Price |
$563.10
|
| Rate for Payer: Cash Price |
$563.10
|
| Rate for Payer: Cigna Commercial |
$1,854.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.78
|
| Rate for Payer: Health EOS Commercial |
$1,776.39
|
| Rate for Payer: HFN Commercial |
$1,854.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.78
|
| Rate for Payer: Multiplan Commercial |
$1,561.66
|
| Rate for Payer: NAPHCARE Commercial |
$178.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.48
|
| Rate for Payer: Quartz Beloit One Network |
$858.92
|
| Rate for Payer: Quartz Commercial |
$1,112.69
|
| Rate for Payer: Quartz Medicare Advantage |
$118.78
|
| Rate for Payer: The Alliance Commercial |
$504.81
|
| Rate for Payer: United Healthcare Medicaid |
$216.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.78
|
| Rate for Payer: WEA Trust Commercial |
$1,073.64
|
| Rate for Payer: WPS Commercial |
$534.50
|
|
|
DX BRONCHOSCOPE/WASH 31622
|
Professional
|
Both
|
$1,632.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
3014398
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.63 |
| Max. Negotiated Rate |
$1,612.42 |
| Rate for Payer: Aetna Commercial |
$1,612.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.66
|
| Rate for Payer: Aetna Managed Medicare |
$116.63
|
| Rate for Payer: Anthem Medicare Advantage |
$116.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.63
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,612.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.63
|
| Rate for Payer: Health EOS Commercial |
$1,544.52
|
| Rate for Payer: HFN Commercial |
$1,612.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.63
|
| Rate for Payer: Multiplan Commercial |
$1,357.82
|
| Rate for Payer: NAPHCARE Commercial |
$174.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.42
|
| Rate for Payer: Quartz Beloit One Network |
$746.80
|
| Rate for Payer: Quartz Commercial |
$967.45
|
| Rate for Payer: Quartz Medicare Advantage |
$116.63
|
| Rate for Payer: The Alliance Commercial |
$495.66
|
| Rate for Payer: United Healthcare Medicaid |
$288.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.63
|
| Rate for Payer: WEA Trust Commercial |
$933.50
|
| Rate for Payer: WPS Commercial |
$524.82
|
|
|
DX LARYNGOSCOPY EXCL NB 31525
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3014386
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.26 |
| Max. Negotiated Rate |
$1,131.26 |
| Rate for Payer: Aetna Commercial |
$1,131.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.09
|
| Rate for Payer: Aetna Managed Medicare |
$132.26
|
| Rate for Payer: Anthem Medicare Advantage |
$132.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.26
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$1,131.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.26
|
| Rate for Payer: Health EOS Commercial |
$1,083.63
|
| Rate for Payer: HFN Commercial |
$1,131.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.26
|
| Rate for Payer: Multiplan Commercial |
$952.64
|
| Rate for Payer: NAPHCARE Commercial |
$198.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.26
|
| Rate for Payer: Quartz Beloit One Network |
$523.95
|
| Rate for Payer: Quartz Commercial |
$678.76
|
| Rate for Payer: Quartz Medicare Advantage |
$132.26
|
| Rate for Payer: The Alliance Commercial |
$562.09
|
| Rate for Payer: United Healthcare Medicaid |
$206.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.26
|
| Rate for Payer: WEA Trust Commercial |
$654.94
|
| Rate for Payer: WPS Commercial |
$595.16
|
|
|
DYNACLIP BONE FIXATION SYSTEM 10MM X 10MM X 10MM 3000-00-101010
|
Facility
|
IP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.36 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,411.06
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
DYNACLIP BONE FIXATION SYSTEM 10MM X 10MM X 10MM 3000-00-101010
|
Facility
|
OP
|
$7,069.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,058.49 |
| Max. Negotiated Rate |
$6,763.62 |
| Rate for Payer: Aetna Commercial |
$6,616.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,322.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,058.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,778.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,675.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,528.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,896.43
|
| Rate for Payer: Cash Price |
$2,120.70
|
| Rate for Payer: Cigna Commercial |
$6,763.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,114.16
|
| Rate for Payer: Health EOS Commercial |
$6,543.07
|
| Rate for Payer: HFN Commercial |
$6,763.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,513.82
|
| Rate for Payer: Multiplan Commercial |
$5,881.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,411.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,763.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,602.36
|
| Rate for Payer: Quartz Commercial |
$4,778.64
|
| Rate for Payer: Quartz Medicare Advantage |
$4,411.06
|
| Rate for Payer: The Alliance Commercial |
$3,675.88
|
| Rate for Payer: WEA Trust Commercial |
$4,043.47
|
| Rate for Payer: WPS Commercial |
$5,445.25
|
|
|
Dynamic Pro/Sup Splint
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
2989898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Dynamic Pro/Sup Splint
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
2989898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$3,179.16 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$301.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$3,179.16
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
