|
External Pacemaker
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
3052550
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Aetna Managed Medicare |
$227.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.51
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$529.10
|
| Rate for Payer: Quartz Medicare Advantage |
$488.40
|
| Rate for Payer: The Alliance Commercial |
$3,256.00
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.35 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Managed Medicare |
$2,303.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,303.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,303.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,303.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,568.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,303.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,303.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,303.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,303.35
|
| Rate for Payer: NAPHCARE Commercial |
$3,455.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,303.35
|
| Rate for Payer: The Alliance Commercial |
$9,213.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,303.35
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,303.35
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
|
Facility
|
OP
|
$20,663.76
|
|
|
Service Code
|
CPT 66991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,165.94 |
| Max. Negotiated Rate |
$20,663.76 |
| Rate for Payer: Aetna Managed Medicare |
$5,165.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5,165.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,165.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,165.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,165.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,165.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,217.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,165.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,165.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,165.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,165.94
|
| Rate for Payer: NAPHCARE Commercial |
$7,748.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5,165.94
|
| Rate for Payer: The Alliance Commercial |
$20,663.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,165.94
|
| Rate for Payer: Wellcare Medicare |
$5,165.94
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.35 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Managed Medicare |
$2,303.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,303.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,303.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,303.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,303.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,568.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,303.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,303.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,303.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,303.35
|
| Rate for Payer: NAPHCARE Commercial |
$3,455.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,303.35
|
| Rate for Payer: The Alliance Commercial |
$9,213.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,303.35
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,303.35
|
|
|
EXTRACORPOREAL SHOCKWAVE LITHOTRIPTOR (ESWL)
|
Facility
|
IP
|
$40,002.00
|
|
| Hospital Charge Code |
2950489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$19,600.98 |
| Max. Negotiated Rate |
$36,801.84 |
| Rate for Payer: Aetna Commercial |
$36,001.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,401.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,201.06
|
| Rate for Payer: Cash Price |
$12,000.60
|
| Rate for Payer: Cigna Commercial |
$36,801.84
|
| Rate for Payer: Health EOS Commercial |
$35,601.78
|
| Rate for Payer: HFN Commercial |
$36,801.84
|
| Rate for Payer: Multiplan Commercial |
$32,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$24,001.20
|
| Rate for Payer: Preferred Network Access Commercial |
$36,801.84
|
| Rate for Payer: Quartz Beloit One Network |
$19,600.98
|
| Rate for Payer: Quartz Commercial |
$24,001.20
|
| Rate for Payer: WEA Trust Commercial |
$22,001.10
|
| Rate for Payer: WPS Commercial |
$29,629.48
|
|
|
EXTRACORPOREAL SHOCKWAVE LITHOTRIPTOR (ESWL)
|
Facility
|
OP
|
$40,002.00
|
|
| Hospital Charge Code |
2950489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,200.56 |
| Max. Negotiated Rate |
$160,008.00 |
| Rate for Payer: Aetna Commercial |
$36,001.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,401.72
|
| Rate for Payer: Aetna Managed Medicare |
$11,200.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,001.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,200.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,201.06
|
| Rate for Payer: Cash Price |
$12,000.60
|
| Rate for Payer: Cigna Commercial |
$36,801.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,385.12
|
| Rate for Payer: Health EOS Commercial |
$35,601.78
|
| Rate for Payer: HFN Commercial |
$36,801.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,001.50
|
| Rate for Payer: Multiplan Commercial |
$32,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$24,001.20
|
| Rate for Payer: Preferred Network Access Commercial |
$36,801.84
|
| Rate for Payer: Quartz Beloit One Network |
$19,600.98
|
| Rate for Payer: Quartz Commercial |
$26,001.30
|
| Rate for Payer: Quartz Medicare Advantage |
$24,001.20
|
| Rate for Payer: The Alliance Commercial |
$160,008.00
|
| Rate for Payer: WEA Trust Commercial |
$22,001.10
|
| Rate for Payer: WPS Commercial |
$29,629.48
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$42,855.00
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$15,415.57 |
| Max. Negotiated Rate |
$42,855.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,415.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,568.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,729.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,444.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,415.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,415.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,415.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,415.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,135.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,415.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,198.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,415.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,415.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,415.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,415.57
|
| Rate for Payer: NAPHCARE Commercial |
$23,123.36
|
| Rate for Payer: Quartz Medicare Advantage |
$15,415.57
|
| Rate for Payer: The Alliance Commercial |
$42,855.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,415.57
|
| Rate for Payer: United Healthcare PPO |
$24,288.08
|
| Rate for Payer: Wellcare Medicare |
$15,415.57
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$90,064.00
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$32,397.12 |
| Max. Negotiated Rate |
$90,064.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,397.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,912.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,353.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,639.64
|
| Rate for Payer: Anthem Medicare Advantage |
$32,397.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,397.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,397.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,397.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,324.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,397.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,824.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,397.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,397.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,397.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,397.12
|
| Rate for Payer: NAPHCARE Commercial |
$48,595.68
|
| Rate for Payer: Quartz Medicare Advantage |
$32,397.12
|
| Rate for Payer: The Alliance Commercial |
$90,064.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,397.12
|
| Rate for Payer: United Healthcare PPO |
$51,244.98
|
| Rate for Payer: Wellcare Medicare |
$32,397.12
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,655.00
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$11,026.99 |
| Max. Negotiated Rate |
$30,655.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,026.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,917.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,332.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,416.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11,026.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,026.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,026.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,026.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,334.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,026.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,249.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,026.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,026.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,026.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,026.99
|
| Rate for Payer: NAPHCARE Commercial |
$16,540.48
|
| Rate for Payer: Quartz Medicare Advantage |
$11,026.99
|
| Rate for Payer: The Alliance Commercial |
$30,655.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,026.99
|
| Rate for Payer: United Healthcare PPO |
$17,321.52
|
| Rate for Payer: Wellcare Medicare |
$11,026.99
|
|
|
EXTRACTOR ATLAS 2.8 4-WIRE G32788
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2965857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.88 |
| Max. Negotiated Rate |
$2,219.04 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,447.20
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
EXTRACTOR ATLAS 2.8 4-WIRE G32788
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2965857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$9,648.00 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Aetna Managed Medicare |
$675.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,567.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.76
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,809.00
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,567.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,447.20
|
| Rate for Payer: The Alliance Commercial |
$9,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
EXTRACTOR CAPTURA 2.8 3-WIRE G32757
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2965858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.36 |
| Max. Negotiated Rate |
$9,648.00 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Aetna Managed Medicare |
$675.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,567.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.76
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,809.00
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,567.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,447.20
|
| Rate for Payer: The Alliance Commercial |
$9,648.00
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
EXTRACTOR CAPTURA 2.8 3-WIRE G32757
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
2965858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.88 |
| Max. Negotiated Rate |
$2,219.04 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,447.20
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
EXTRACTOR CAPTURA 2.8 4-WIRE G32756
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
EXTRACTOR CAPTURA 2.8 4-WIRE G32756
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
EXTRACTOR NCIRCLE 1.5FR 115CM G46206
|
Facility
|
IP
|
$1,726.00
|
|
| Hospital Charge Code |
2965860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$845.74 |
| Max. Negotiated Rate |
$1,587.92 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,035.60
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
EXTRACTOR NCIRCLE 1.5FR 115CM G46206
|
Facility
|
OP
|
$1,726.00
|
|
| Hospital Charge Code |
2965860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$483.28 |
| Max. Negotiated Rate |
$6,904.00 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Aetna Managed Medicare |
$483.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$863.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.87
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,294.50
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,121.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.60
|
| Rate for Payer: The Alliance Commercial |
$6,904.00
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
EXTRACTOR NCIRCLE 2.2FR 115CM G18778
|
Facility
|
OP
|
$2,833.00
|
|
| Hospital Charge Code |
2965861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$793.24 |
| Max. Negotiated Rate |
$11,332.00 |
| Rate for Payer: Aetna Commercial |
$2,549.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.38
|
| Rate for Payer: Aetna Managed Medicare |
$793.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,841.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,416.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,359.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.49
|
| Rate for Payer: Cash Price |
$849.90
|
| Rate for Payer: Cigna Commercial |
$2,606.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,585.35
|
| Rate for Payer: Health EOS Commercial |
$2,521.37
|
| Rate for Payer: HFN Commercial |
$2,606.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,124.75
|
| Rate for Payer: Multiplan Commercial |
$2,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.17
|
| Rate for Payer: Quartz Commercial |
$1,841.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,699.80
|
| Rate for Payer: The Alliance Commercial |
$11,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,558.15
|
| Rate for Payer: WPS Commercial |
$2,098.40
|
|
|
EXTRACTOR NCIRCLE 2.2FR 115CM G18778
|
Facility
|
IP
|
$2,833.00
|
|
| Hospital Charge Code |
2965861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,388.17 |
| Max. Negotiated Rate |
$2,606.36 |
| Rate for Payer: Aetna Commercial |
$2,549.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,436.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,501.49
|
| Rate for Payer: Cash Price |
$849.90
|
| Rate for Payer: Cigna Commercial |
$2,606.36
|
| Rate for Payer: Health EOS Commercial |
$2,521.37
|
| Rate for Payer: HFN Commercial |
$2,606.36
|
| Rate for Payer: Multiplan Commercial |
$2,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,699.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,606.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,388.17
|
| Rate for Payer: Quartz Commercial |
$1,699.80
|
| Rate for Payer: WEA Trust Commercial |
$1,558.15
|
| Rate for Payer: WPS Commercial |
$2,098.40
|
|
|
EXTRACTOR NGAGE NITINOL STONE 2.2FR/115CM G48297
|
Facility
|
IP
|
$2,870.00
|
|
| Hospital Charge Code |
2965862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,406.30 |
| Max. Negotiated Rate |
$2,640.40 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,722.00
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
EXTRACTOR NGAGE NITINOL STONE 2.2FR/115CM G48297
|
Facility
|
OP
|
$2,870.00
|
|
| Hospital Charge Code |
2965862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$11,480.00 |
| Rate for Payer: Aetna Commercial |
$2,583.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.20
|
| Rate for Payer: Aetna Managed Medicare |
$803.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,865.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,435.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,377.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.10
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,640.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,606.05
|
| Rate for Payer: Health EOS Commercial |
$2,554.30
|
| Rate for Payer: HFN Commercial |
$2,640.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,152.50
|
| Rate for Payer: Multiplan Commercial |
$2,296.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.30
|
| Rate for Payer: Quartz Commercial |
$1,865.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,722.00
|
| Rate for Payer: The Alliance Commercial |
$11,480.00
|
| Rate for Payer: WEA Trust Commercial |
$1,578.50
|
| Rate for Payer: WPS Commercial |
$2,125.81
|
|
|
EXTRACTOR NTRAP 2.8FR 145CM G32724
|
Facility
|
OP
|
$2,952.00
|
|
| Hospital Charge Code |
2965863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$826.56 |
| Max. Negotiated Rate |
$11,808.00 |
| Rate for Payer: Aetna Commercial |
$2,656.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,538.72
|
| Rate for Payer: Aetna Managed Medicare |
$826.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,918.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,416.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,564.56
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$2,715.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,651.94
|
| Rate for Payer: Health EOS Commercial |
$2,627.28
|
| Rate for Payer: HFN Commercial |
$2,715.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.00
|
| Rate for Payer: Multiplan Commercial |
$2,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,715.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.48
|
| Rate for Payer: Quartz Commercial |
$1,918.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.20
|
| Rate for Payer: The Alliance Commercial |
$11,808.00
|
| Rate for Payer: WEA Trust Commercial |
$1,623.60
|
| Rate for Payer: WPS Commercial |
$2,186.55
|
|
|
EXTRACTOR NTRAP 2.8FR 145CM G32724
|
Facility
|
IP
|
$2,952.00
|
|
| Hospital Charge Code |
2965863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.48 |
| Max. Negotiated Rate |
$2,715.84 |
| Rate for Payer: Aetna Commercial |
$2,656.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,538.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,564.56
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$2,715.84
|
| Rate for Payer: Health EOS Commercial |
$2,627.28
|
| Rate for Payer: HFN Commercial |
$2,715.84
|
| Rate for Payer: Multiplan Commercial |
$2,361.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,715.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.48
|
| Rate for Payer: Quartz Commercial |
$1,771.20
|
| Rate for Payer: WEA Trust Commercial |
$1,623.60
|
| Rate for Payer: WPS Commercial |
$2,186.55
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$41,911.00
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$15,076.07 |
| Max. Negotiated Rate |
$41,911.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,076.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,728.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,086.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,833.68
|
| Rate for Payer: Anthem Medicare Advantage |
$15,076.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,076.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,076.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,076.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,457.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,076.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,505.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,076.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,076.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,076.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,076.07
|
| Rate for Payer: NAPHCARE Commercial |
$22,614.10
|
| Rate for Payer: Quartz Medicare Advantage |
$15,076.07
|
| Rate for Payer: The Alliance Commercial |
$41,911.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,076.07
|
| Rate for Payer: United Healthcare PPO |
$23,749.16
|
| Rate for Payer: Wellcare Medicare |
$15,076.07
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$159,839.00
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$3,194.00 |
| Max. Negotiated Rate |
$159,839.00 |
| Rate for Payer: Aetna Managed Medicare |
$57,496.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,079.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,446.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,273.00
|
| Rate for Payer: Anthem Medicare Advantage |
$57,496.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57,496.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57,496.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$57,496.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101,759.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$57,496.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117,002.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57,496.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57,496.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$57,496.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$57,496.00
|
| Rate for Payer: NAPHCARE Commercial |
$86,244.00
|
| Rate for Payer: Quartz Medicare Advantage |
$57,496.00
|
| Rate for Payer: The Alliance Commercial |
$159,839.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57,496.00
|
| Rate for Payer: United Healthcare PPO |
$3,194.00
|
| Rate for Payer: Wellcare Medicare |
$57,496.00
|
|
