|
EMBOLECTOMY/THROMBECTOMY
|
Facility
|
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2960004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,875.56 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Aetna Managed Medicare |
$4,875.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,318.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,706.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,358.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,744.43
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,059.54
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: NAPHCARE Commercial |
$10,447.63
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$11,318.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10,447.63
|
| Rate for Payer: The Alliance Commercial |
$8,706.36
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
EMBOLECTOMY/THROMBECTOMY
|
Facility
|
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2960004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,532.23 |
| Max. Negotiated Rate |
$16,019.70 |
| Rate for Payer: Aetna Commercial |
$15,671.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,974.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,228.74
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$16,019.70
|
| Rate for Payer: Health EOS Commercial |
$15,497.32
|
| Rate for Payer: HFN Commercial |
$16,019.70
|
| Rate for Payer: Multiplan Commercial |
$13,930.18
|
| Rate for Payer: Preferred Network Access Commercial |
$16,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$8,532.23
|
| Rate for Payer: Quartz Commercial |
$10,447.63
|
| Rate for Payer: WEA Trust Commercial |
$9,577.00
|
| Rate for Payer: WPS Commercial |
$12,897.13
|
|
|
Embolect-Thrombectomy Fem-Pop by Leg Incision
|
Facility
|
IP
|
$28,175.00
|
|
|
Service Code
|
CPT 34201
|
| Hospital Charge Code |
5416676
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14,357.98 |
| Max. Negotiated Rate |
$26,957.84 |
| Rate for Payer: Aetna Commercial |
$26,371.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,199.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,530.06
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cigna Commercial |
$26,957.84
|
| Rate for Payer: Health EOS Commercial |
$26,078.78
|
| Rate for Payer: HFN Commercial |
$26,957.84
|
| Rate for Payer: Multiplan Commercial |
$23,441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$26,957.84
|
| Rate for Payer: Quartz Beloit One Network |
$14,357.98
|
| Rate for Payer: Quartz Commercial |
$17,581.20
|
| Rate for Payer: WEA Trust Commercial |
$16,116.10
|
| Rate for Payer: WPS Commercial |
$21,703.20
|
|
|
Embolect-Thrombectomy Fem-Pop by Leg Incision
|
Facility
|
OP
|
$28,175.00
|
|
|
Service Code
|
CPT 34201
|
| Hospital Charge Code |
5416676
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$5,856.01 |
| Max. Negotiated Rate |
$26,957.84 |
| Rate for Payer: Aetna Commercial |
$26,371.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,199.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,046.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,651.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,064.96
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,530.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cigna Commercial |
$26,957.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$26,078.78
|
| Rate for Payer: HFN Commercial |
$26,957.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$23,441.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$26,957.84
|
| Rate for Payer: Quartz Beloit One Network |
$14,357.98
|
| Rate for Payer: Quartz Commercial |
$19,046.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$21,976.50
|
| Rate for Payer: WEA Trust Commercial |
$16,116.10
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$21,703.20
|
|
|
Embolization Therapy
|
Facility
|
IP
|
$10,036.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
3052434
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$5,114.35 |
| Max. Negotiated Rate |
$9,602.44 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,262.46
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
Embolization Therapy
|
Facility
|
OP
|
$10,036.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
3052434
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$9,602.44 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,922.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,784.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,218.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,009.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,840.95
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,828.08
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: NAPHCARE Commercial |
$6,262.46
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,784.34
|
| Rate for Payer: Quartz Medicare Advantage |
$6,262.46
|
| Rate for Payer: The Alliance Commercial |
$1,228.61
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
Emend 1 mg Charge
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Emend 1 mg Charge
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.18
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$0.46
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$0.34
|
|
|
Emend 1 mg Charge
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$0.11
|
| Rate for Payer: Anthem Medicare Advantage |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.11
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.14
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$0.17
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$0.11
|
| Rate for Payer: The Alliance Commercial |
$0.31
|
| Rate for Payer: United Healthcare Medicaid |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$0.34
|
|
|
Emergency Room Intubation - Artificial Airway Type
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
3715563
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.26 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.60
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.26
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$249.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$249.26
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$249.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$249.26
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$342.06
|
| Rate for Payer: Quartz Medicare Advantage |
$249.26
|
| Rate for Payer: The Alliance Commercial |
$997.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
Emergency Room Intubation - Artificial Airway Type
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
3715563
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$315.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
Emergency Room Intubation* - Artificial Airway Type:
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5506773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$315.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
Emergency Room Intubation* - Artificial Airway Type:
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5506773
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.26 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.60
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.26
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$249.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$249.26
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$249.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$249.26
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$342.06
|
| Rate for Payer: Quartz Medicare Advantage |
$249.26
|
| Rate for Payer: The Alliance Commercial |
$997.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
EMERGING TECHNOLOGY PROCEDURES
|
Facility
|
OP
|
$58.96
|
|
|
Service Code
|
EAPG 04001
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Anthem Medicaid |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$56.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.70
|
| Rate for Payer: Dean Health Medicaid |
$56.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$56.70
|
| Rate for Payer: Managed Health Services Medicaid |
$58.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$56.70
|
| Rate for Payer: United Healthcare Medicaid |
$56.70
|
|
|
ENCCENTER TI HUMERAL STEM
|
Facility
|
IP
|
$5,290.00
|
|
| Hospital Charge Code |
2966228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.78 |
| Max. Negotiated Rate |
$5,061.47 |
| Rate for Payer: Aetna Commercial |
$4,951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,731.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,915.85
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$5,061.47
|
| Rate for Payer: Health EOS Commercial |
$4,896.42
|
| Rate for Payer: HFN Commercial |
$5,061.47
|
| Rate for Payer: Multiplan Commercial |
$4,401.28
|
| Rate for Payer: Preferred Network Access Commercial |
$5,061.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,695.78
|
| Rate for Payer: Quartz Commercial |
$3,300.96
|
| Rate for Payer: WEA Trust Commercial |
$3,025.88
|
| Rate for Payer: WPS Commercial |
$4,074.89
|
|
|
ENCCENTER TI HUMERAL STEM
|
Facility
|
OP
|
$5,290.00
|
|
| Hospital Charge Code |
2966228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.45 |
| Max. Negotiated Rate |
$5,061.47 |
| Rate for Payer: Aetna Commercial |
$4,951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,731.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,540.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,576.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,750.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,640.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,915.85
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$5,061.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,078.78
|
| Rate for Payer: Health EOS Commercial |
$4,896.42
|
| Rate for Payer: HFN Commercial |
$5,061.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,126.20
|
| Rate for Payer: Multiplan Commercial |
$4,401.28
|
| Rate for Payer: NAPHCARE Commercial |
$3,300.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,061.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,695.78
|
| Rate for Payer: Quartz Commercial |
$3,576.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,300.96
|
| Rate for Payer: The Alliance Commercial |
$2,750.80
|
| Rate for Payer: WEA Trust Commercial |
$3,025.88
|
| Rate for Payer: WPS Commercial |
$4,074.89
|
|
|
ENCOUNTERS FOR CONTACT WITH HEALTH SERVICES
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00867
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
END CAP 12MM +5 1818-0005S
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
END CAP 12MM +5 1818-0005S
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6211055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.56 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$959.92
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
END CAP #456.311
|
Facility
|
OP
|
$2,429.00
|
|
| Hospital Charge Code |
2966229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.32 |
| Max. Negotiated Rate |
$2,324.07 |
| Rate for Payer: Aetna Commercial |
$2,273.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,172.50
|
| Rate for Payer: Aetna Managed Medicare |
$707.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,642.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,263.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,212.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.86
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cigna Commercial |
$2,324.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,413.68
|
| Rate for Payer: Health EOS Commercial |
$2,248.28
|
| Rate for Payer: HFN Commercial |
$2,324.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,894.62
|
| Rate for Payer: Multiplan Commercial |
$2,020.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,515.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,324.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.82
|
| Rate for Payer: Quartz Commercial |
$1,642.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,515.70
|
| Rate for Payer: The Alliance Commercial |
$1,263.08
|
| Rate for Payer: WEA Trust Commercial |
$1,389.39
|
| Rate for Payer: WPS Commercial |
$1,871.06
|
|
|
END CAP #456.311
|
Facility
|
IP
|
$2,429.00
|
|
| Hospital Charge Code |
2966229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.82 |
| Max. Negotiated Rate |
$2,324.07 |
| Rate for Payer: Aetna Commercial |
$2,273.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,172.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.86
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cigna Commercial |
$2,324.07
|
| Rate for Payer: Health EOS Commercial |
$2,248.28
|
| Rate for Payer: HFN Commercial |
$2,324.07
|
| Rate for Payer: Multiplan Commercial |
$2,020.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,324.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.82
|
| Rate for Payer: Quartz Commercial |
$1,515.70
|
| Rate for Payer: WEA Trust Commercial |
$1,389.39
|
| Rate for Payer: WPS Commercial |
$1,871.06
|
|
|
END CAP 8MM X 10MM 2381-0810S
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.59 |
| Max. Negotiated Rate |
$2,370.95 |
| Rate for Payer: Aetna Commercial |
$2,319.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.32
|
| Rate for Payer: Aetna Managed Medicare |
$721.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.87
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,370.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.20
|
| Rate for Payer: Health EOS Commercial |
$2,293.64
|
| Rate for Payer: HFN Commercial |
$2,370.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.84
|
| Rate for Payer: Multiplan Commercial |
$2,061.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.79
|
| Rate for Payer: Quartz Commercial |
$1,675.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.27
|
| Rate for Payer: The Alliance Commercial |
$1,288.56
|
| Rate for Payer: WEA Trust Commercial |
$1,417.42
|
| Rate for Payer: WPS Commercial |
$1,908.80
|
|
|
END CAP 8MM X 10MM 2381-0810S
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6171934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,262.79 |
| Max. Negotiated Rate |
$2,370.95 |
| Rate for Payer: Aetna Commercial |
$2,319.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.87
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,370.95
|
| Rate for Payer: Health EOS Commercial |
$2,293.64
|
| Rate for Payer: HFN Commercial |
$2,370.95
|
| Rate for Payer: Multiplan Commercial |
$2,061.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.79
|
| Rate for Payer: Quartz Commercial |
$1,546.27
|
| Rate for Payer: WEA Trust Commercial |
$1,417.42
|
| Rate for Payer: WPS Commercial |
$1,908.80
|
|
|
END CAP FEMORAL NAIL TI 50MM 04.233.000S
|
Facility
|
OP
|
$2,344.11
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.60 |
| Max. Negotiated Rate |
$2,242.84 |
| Rate for Payer: Aetna Commercial |
$2,194.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,096.57
|
| Rate for Payer: Aetna Managed Medicare |
$682.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,584.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,218.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,170.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.07
|
| Rate for Payer: Cash Price |
$703.23
|
| Rate for Payer: Cigna Commercial |
$2,242.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.27
|
| Rate for Payer: Health EOS Commercial |
$2,169.71
|
| Rate for Payer: HFN Commercial |
$2,242.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,828.41
|
| Rate for Payer: Multiplan Commercial |
$1,950.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,462.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.56
|
| Rate for Payer: Quartz Commercial |
$1,584.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,462.72
|
| Rate for Payer: The Alliance Commercial |
$1,218.94
|
| Rate for Payer: WEA Trust Commercial |
$1,340.83
|
| Rate for Payer: WPS Commercial |
$1,805.67
|
|
|
END CAP FEMORAL NAIL TI 50MM 04.233.000S
|
Facility
|
IP
|
$2,344.11
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6246190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.56 |
| Max. Negotiated Rate |
$2,242.84 |
| Rate for Payer: Aetna Commercial |
$2,194.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,096.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.07
|
| Rate for Payer: Cash Price |
$703.23
|
| Rate for Payer: Cigna Commercial |
$2,242.84
|
| Rate for Payer: Health EOS Commercial |
$2,169.71
|
| Rate for Payer: HFN Commercial |
$2,242.84
|
| Rate for Payer: Multiplan Commercial |
$1,950.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.56
|
| Rate for Payer: Quartz Commercial |
$1,462.72
|
| Rate for Payer: WEA Trust Commercial |
$1,340.83
|
| Rate for Payer: WPS Commercial |
$1,805.67
|
|
