|
EMBOLECTOMY/THROMBECTOMY
|
Facility
|
OP
|
$16,743.00
|
|
| Hospital Charge Code |
2960004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,688.04 |
| Max. Negotiated Rate |
$66,972.00 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| Rate for Payer: Aetna Managed Medicare |
$4,688.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,882.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,036.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,369.38
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,557.25
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,882.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10,045.80
|
| Rate for Payer: The Alliance Commercial |
$66,972.00
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
|
EMBOLECTOMY/THROMBECTOMY
|
Facility
|
IP
|
$16,743.00
|
|
| Hospital Charge Code |
2960004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,204.07 |
| Max. Negotiated Rate |
$15,403.56 |
| Rate for Payer: Aetna Commercial |
$15,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,398.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,873.79
|
| Rate for Payer: Cash Price |
$5,022.90
|
| Rate for Payer: Cigna Commercial |
$15,403.56
|
| Rate for Payer: Health EOS Commercial |
$14,901.27
|
| Rate for Payer: HFN Commercial |
$15,403.56
|
| Rate for Payer: Multiplan Commercial |
$13,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,403.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,204.07
|
| Rate for Payer: Quartz Commercial |
$10,045.80
|
| Rate for Payer: WEA Trust Commercial |
$9,208.65
|
| Rate for Payer: WPS Commercial |
$12,401.54
|
|
|
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 |
$5,431.64 |
| Max. Negotiated Rate |
$25,921.00 |
| Rate for Payer: Aetna Commercial |
$25,357.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,230.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,313.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,087.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,524.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,932.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cigna Commercial |
$25,921.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$25,075.75
|
| Rate for Payer: HFN Commercial |
$25,921.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$22,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25,921.00
|
| Rate for Payer: Quartz Beloit One Network |
$13,805.75
|
| Rate for Payer: Quartz Commercial |
$18,313.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$21,131.25
|
| Rate for Payer: WEA Trust Commercial |
$15,496.25
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$20,869.22
|
|
|
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 |
$13,805.75 |
| Max. Negotiated Rate |
$25,921.00 |
| Rate for Payer: Aetna Commercial |
$25,357.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,230.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,932.75
|
| Rate for Payer: Cash Price |
$8,452.50
|
| Rate for Payer: Cigna Commercial |
$25,921.00
|
| Rate for Payer: Health EOS Commercial |
$25,075.75
|
| Rate for Payer: HFN Commercial |
$25,921.00
|
| Rate for Payer: Multiplan Commercial |
$22,540.00
|
| Rate for Payer: NAPHCARE Commercial |
$16,905.00
|
| Rate for Payer: Preferred Network Access Commercial |
$25,921.00
|
| Rate for Payer: Quartz Beloit One Network |
$13,805.75
|
| Rate for Payer: Quartz Commercial |
$16,905.00
|
| Rate for Payer: WEA Trust Commercial |
$15,496.25
|
| Rate for Payer: WPS Commercial |
$20,869.22
|
|
|
Embolization Therapy
|
Facility
|
IP
|
$10,036.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
3052434
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$4,917.64 |
| Max. Negotiated Rate |
$9,233.12 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,021.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,021.60
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
Embolization Therapy
|
Facility
|
OP
|
$10,036.00
|
|
|
Service Code
|
CPT 75894
|
| Hospital Charge Code |
3052434
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$40,144.00 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,810.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,523.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,018.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,817.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,616.15
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,527.00
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,021.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,523.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,021.60
|
| Rate for Payer: The Alliance Commercial |
$40,144.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
Emend 1 mg Charge
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Emend 1 mg Charge
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.13
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: HFN Commercial |
$17.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.13
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$0.33
|
|
|
Emend 1 mg Charge
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
2958913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.17
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$0.33
|
|
|
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 |
$247.94 |
| Max. Negotiated Rate |
$465.52 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$303.60
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$303.60
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
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 |
$241.43 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Aetna Managed Medicare |
$241.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.88
|
| Rate for Payer: Anthem Medicare Advantage |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
| 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 |
$465.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$362.14
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$328.90
|
| Rate for Payer: Quartz Medicare Advantage |
$241.43
|
| Rate for Payer: The Alliance Commercial |
$965.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: Wellcare Medicare |
$241.43
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
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 |
$247.94 |
| Max. Negotiated Rate |
$465.52 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$303.60
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$303.60
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
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 |
$241.43 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Aetna Managed Medicare |
$241.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.88
|
| Rate for Payer: Anthem Medicare Advantage |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
| 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 |
$465.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$362.14
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$328.90
|
| Rate for Payer: Quartz Medicare Advantage |
$241.43
|
| Rate for Payer: The Alliance Commercial |
$965.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: Wellcare Medicare |
$241.43
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
ENCCENTER TI HUMERAL STEM
|
Facility
|
IP
|
$5,290.00
|
|
| Hospital Charge Code |
2966228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.10 |
| Max. Negotiated Rate |
$4,866.80 |
| Rate for Payer: Aetna Commercial |
$4,761.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,549.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,803.70
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$4,866.80
|
| Rate for Payer: Health EOS Commercial |
$4,708.10
|
| Rate for Payer: HFN Commercial |
$4,866.80
|
| Rate for Payer: Multiplan Commercial |
$4,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,866.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.10
|
| Rate for Payer: Quartz Commercial |
$3,174.00
|
| Rate for Payer: WEA Trust Commercial |
$2,909.50
|
| Rate for Payer: WPS Commercial |
$3,918.30
|
|
|
ENCCENTER TI HUMERAL STEM
|
Facility
|
OP
|
$5,290.00
|
|
| Hospital Charge Code |
2966228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.20 |
| Max. Negotiated Rate |
$21,160.00 |
| Rate for Payer: Aetna Commercial |
$4,761.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,549.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,481.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,438.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,645.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,539.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,803.70
|
| Rate for Payer: Cash Price |
$1,587.00
|
| Rate for Payer: Cigna Commercial |
$4,866.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,960.28
|
| Rate for Payer: Health EOS Commercial |
$4,708.10
|
| Rate for Payer: HFN Commercial |
$4,866.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,967.50
|
| Rate for Payer: Multiplan Commercial |
$4,232.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,866.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,592.10
|
| Rate for Payer: Quartz Commercial |
$3,438.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,174.00
|
| Rate for Payer: The Alliance Commercial |
$21,160.00
|
| Rate for Payer: WEA Trust Commercial |
$2,909.50
|
| Rate for Payer: WPS Commercial |
$3,918.30
|
|
|
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 |
$516.88 |
| Max. Negotiated Rate |
$7,384.00 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$7,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
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 |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
END CAP #456.311
|
Facility
|
OP
|
$2,429.00
|
|
| Hospital Charge Code |
2966229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$680.12 |
| Max. Negotiated Rate |
$9,716.00 |
| Rate for Payer: Aetna Commercial |
$2,186.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.94
|
| Rate for Payer: Aetna Managed Medicare |
$680.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,578.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,214.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,165.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.37
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cigna Commercial |
$2,234.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,359.27
|
| Rate for Payer: Health EOS Commercial |
$2,161.81
|
| Rate for Payer: HFN Commercial |
$2,234.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,943.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,190.21
|
| Rate for Payer: Quartz Commercial |
$1,578.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,457.40
|
| Rate for Payer: The Alliance Commercial |
$9,716.00
|
| Rate for Payer: WEA Trust Commercial |
$1,335.95
|
| Rate for Payer: WPS Commercial |
$1,799.16
|
|
|
END CAP #456.311
|
Facility
|
IP
|
$2,429.00
|
|
| Hospital Charge Code |
2966229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.21 |
| Max. Negotiated Rate |
$2,234.68 |
| Rate for Payer: Aetna Commercial |
$2,186.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,088.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,287.37
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cigna Commercial |
$2,234.68
|
| Rate for Payer: Health EOS Commercial |
$2,161.81
|
| Rate for Payer: HFN Commercial |
$2,234.68
|
| Rate for Payer: Multiplan Commercial |
$1,943.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,457.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,190.21
|
| Rate for Payer: Quartz Commercial |
$1,457.40
|
| Rate for Payer: WEA Trust Commercial |
$1,335.95
|
| Rate for Payer: WPS Commercial |
$1,799.16
|
|
|
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 |
$1,214.22 |
| Max. Negotiated Rate |
$2,279.76 |
| Rate for Payer: Aetna Commercial |
$2,230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.34
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,279.76
|
| Rate for Payer: Health EOS Commercial |
$2,205.42
|
| Rate for Payer: HFN Commercial |
$2,279.76
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.22
|
| Rate for Payer: Quartz Commercial |
$1,486.80
|
| Rate for Payer: WEA Trust Commercial |
$1,362.90
|
| Rate for Payer: WPS Commercial |
$1,835.45
|
|
|
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 |
$693.84 |
| Max. Negotiated Rate |
$9,912.00 |
| Rate for Payer: Aetna Commercial |
$2,230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.08
|
| Rate for Payer: Aetna Managed Medicare |
$693.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,610.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,189.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.34
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,279.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,386.69
|
| Rate for Payer: Health EOS Commercial |
$2,205.42
|
| Rate for Payer: HFN Commercial |
$2,279.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.50
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.22
|
| Rate for Payer: Quartz Commercial |
$1,610.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,486.80
|
| Rate for Payer: The Alliance Commercial |
$9,912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,362.90
|
| Rate for Payer: WPS Commercial |
$1,835.45
|
|
|
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 |
$656.35 |
| Max. Negotiated Rate |
$9,376.44 |
| Rate for Payer: Aetna Commercial |
$2,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,015.93
|
| Rate for Payer: Aetna Managed Medicare |
$656.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,523.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,172.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,125.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.38
|
| Rate for Payer: Cash Price |
$703.23
|
| Rate for Payer: Cigna Commercial |
$2,156.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,311.76
|
| Rate for Payer: Health EOS Commercial |
$2,086.26
|
| Rate for Payer: HFN Commercial |
$2,156.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,758.08
|
| Rate for Payer: Multiplan Commercial |
$1,875.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,406.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,156.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.61
|
| Rate for Payer: Quartz Commercial |
$1,523.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,406.47
|
| Rate for Payer: The Alliance Commercial |
$9,376.44
|
| Rate for Payer: WEA Trust Commercial |
$1,289.26
|
| Rate for Payer: WPS Commercial |
$1,736.28
|
|
|
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 |
$1,148.61 |
| Max. Negotiated Rate |
$2,156.58 |
| Rate for Payer: Aetna Commercial |
$2,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,015.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,242.38
|
| Rate for Payer: Cash Price |
$703.23
|
| Rate for Payer: Cigna Commercial |
$2,156.58
|
| Rate for Payer: Health EOS Commercial |
$2,086.26
|
| Rate for Payer: HFN Commercial |
$2,156.58
|
| Rate for Payer: Multiplan Commercial |
$1,875.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,406.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,156.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.61
|
| Rate for Payer: Quartz Commercial |
$1,406.47
|
| Rate for Payer: WEA Trust Commercial |
$1,289.26
|
| Rate for Payer: WPS Commercial |
$1,736.28
|
|
|
END CAP FEMORAL NAIL TI 5MM 04.233.005S
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,242.64 |
| Max. Negotiated Rate |
$2,333.12 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,521.60
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
|
END CAP FEMORAL NAIL TI 5MM 04.233.005S
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6175478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.08 |
| Max. Negotiated Rate |
$10,144.00 |
| Rate for Payer: Aetna Commercial |
$2,282.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,180.96
|
| Rate for Payer: Aetna Managed Medicare |
$710.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.08
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cigna Commercial |
$2,333.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.15
|
| Rate for Payer: Health EOS Commercial |
$2,257.04
|
| Rate for Payer: HFN Commercial |
$2,333.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.64
|
| Rate for Payer: Quartz Commercial |
$1,648.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.60
|
| Rate for Payer: The Alliance Commercial |
$10,144.00
|
| Rate for Payer: WEA Trust Commercial |
$1,394.80
|
| Rate for Payer: WPS Commercial |
$1,878.42
|
|
