|
IMPLANT 42/15.75MM COCR HEAD
|
Facility
|
IP
|
$13,932.00
|
|
| Hospital Charge Code |
2966258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,099.75 |
| Max. Negotiated Rate |
$13,330.14 |
| Rate for Payer: Aetna Commercial |
$13,040.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,460.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,679.32
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$13,330.14
|
| Rate for Payer: Health EOS Commercial |
$12,895.46
|
| Rate for Payer: HFN Commercial |
$13,330.14
|
| Rate for Payer: Multiplan Commercial |
$11,591.42
|
| Rate for Payer: Preferred Network Access Commercial |
$13,330.14
|
| Rate for Payer: Quartz Beloit One Network |
$7,099.75
|
| Rate for Payer: Quartz Commercial |
$8,693.57
|
| Rate for Payer: WEA Trust Commercial |
$7,969.10
|
| Rate for Payer: WPS Commercial |
$10,731.82
|
|
|
IMPLANT 42/15.75MM COCR HEAD
|
Facility
|
OP
|
$13,932.00
|
|
| Hospital Charge Code |
2966258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,057.00 |
| Max. Negotiated Rate |
$13,330.14 |
| Rate for Payer: Aetna Commercial |
$13,040.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,460.78
|
| Rate for Payer: Aetna Managed Medicare |
$4,057.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,418.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,244.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,954.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,679.32
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$13,330.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,108.42
|
| Rate for Payer: Health EOS Commercial |
$12,895.46
|
| Rate for Payer: HFN Commercial |
$13,330.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.96
|
| Rate for Payer: Multiplan Commercial |
$11,591.42
|
| Rate for Payer: NAPHCARE Commercial |
$8,693.57
|
| Rate for Payer: Preferred Network Access Commercial |
$13,330.14
|
| Rate for Payer: Quartz Beloit One Network |
$7,099.75
|
| Rate for Payer: Quartz Commercial |
$9,418.03
|
| Rate for Payer: Quartz Medicare Advantage |
$8,693.57
|
| Rate for Payer: The Alliance Commercial |
$7,244.64
|
| Rate for Payer: WEA Trust Commercial |
$7,969.10
|
| Rate for Payer: WPS Commercial |
$10,731.82
|
|
|
IMPLANT 42MM GLENOID SYNTHES
|
Facility
|
OP
|
$6,804.00
|
|
| Hospital Charge Code |
2966259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,981.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,981.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,599.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,538.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,396.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,959.93
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,307.12
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: NAPHCARE Commercial |
$4,245.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,599.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,245.70
|
| Rate for Payer: The Alliance Commercial |
$3,538.08
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
|
IMPLANT 42MM GLENOID SYNTHES
|
Facility
|
IP
|
$6,804.00
|
|
| Hospital Charge Code |
2966259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,245.70
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
|
IMPLANT 550CC PROFILE SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.59 |
| Max. Negotiated Rate |
$7,883.08 |
| Rate for Payer: Aetna Commercial |
$7,711.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,541.34
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,883.08
|
| Rate for Payer: Health EOS Commercial |
$7,626.02
|
| Rate for Payer: HFN Commercial |
$7,883.08
|
| Rate for Payer: Multiplan Commercial |
$6,854.85
|
| Rate for Payer: Preferred Network Access Commercial |
$7,883.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.59
|
| Rate for Payer: Quartz Commercial |
$5,141.14
|
| Rate for Payer: WEA Trust Commercial |
$4,712.71
|
| Rate for Payer: WPS Commercial |
$6,346.50
|
|
|
IMPLANT 550CC PROFILE SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$7,883.08 |
| Rate for Payer: Aetna Commercial |
$7,711.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,399.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,569.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,284.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,541.34
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,883.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,795.10
|
| Rate for Payer: Health EOS Commercial |
$7,626.02
|
| Rate for Payer: HFN Commercial |
$7,883.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,426.42
|
| Rate for Payer: Multiplan Commercial |
$6,854.85
|
| Rate for Payer: NAPHCARE Commercial |
$5,141.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,883.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.59
|
| Rate for Payer: Quartz Commercial |
$5,569.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5,141.14
|
| Rate for Payer: The Alliance Commercial |
$4,284.28
|
| Rate for Payer: WEA Trust Commercial |
$4,712.71
|
| Rate for Payer: WPS Commercial |
$6,346.50
|
|
|
IMPLANT 650CC PROFILE SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$7,883.08 |
| Rate for Payer: Aetna Commercial |
$7,711.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,399.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,569.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,284.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,112.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,541.34
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,883.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,795.10
|
| Rate for Payer: Health EOS Commercial |
$7,626.02
|
| Rate for Payer: HFN Commercial |
$7,883.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,426.42
|
| Rate for Payer: Multiplan Commercial |
$6,854.85
|
| Rate for Payer: NAPHCARE Commercial |
$5,141.14
|
| Rate for Payer: Preferred Network Access Commercial |
$7,883.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.59
|
| Rate for Payer: Quartz Commercial |
$5,569.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5,141.14
|
| Rate for Payer: The Alliance Commercial |
$4,284.28
|
| Rate for Payer: WEA Trust Commercial |
$4,712.71
|
| Rate for Payer: WPS Commercial |
$6,346.50
|
|
|
IMPLANT 650CC PROFILE SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.59 |
| Max. Negotiated Rate |
$7,883.08 |
| Rate for Payer: Aetna Commercial |
$7,711.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,541.34
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,883.08
|
| Rate for Payer: Health EOS Commercial |
$7,626.02
|
| Rate for Payer: HFN Commercial |
$7,883.08
|
| Rate for Payer: Multiplan Commercial |
$6,854.85
|
| Rate for Payer: Preferred Network Access Commercial |
$7,883.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.59
|
| Rate for Payer: Quartz Commercial |
$5,141.14
|
| Rate for Payer: WEA Trust Commercial |
$4,712.71
|
| Rate for Payer: WPS Commercial |
$6,346.50
|
|
|
IMPLANTABLE CARDIOVASCULAR MONITOR SYSTEM 93290
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
3015363
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$292.45 |
| Rate for Payer: Aetna Commercial |
$292.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Managed Medicare |
$52.41
|
| Rate for Payer: Anthem Medicare Advantage |
$52.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.41
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$292.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.41
|
| Rate for Payer: Health EOS Commercial |
$280.13
|
| Rate for Payer: HFN Commercial |
$292.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.41
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: NAPHCARE Commercial |
$78.61
|
| Rate for Payer: Preferred Network Access Commercial |
$292.45
|
| Rate for Payer: Quartz Beloit One Network |
$135.45
|
| Rate for Payer: Quartz Commercial |
$175.47
|
| Rate for Payer: Quartz Medicare Advantage |
$52.41
|
| Rate for Payer: The Alliance Commercial |
$199.14
|
| Rate for Payer: United Healthcare Medicaid |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.41
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$119,249.02
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$105,924.42 |
| Max. Negotiated Rate |
$119,249.02 |
| Rate for Payer: Anthem Medicaid |
$114,187.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$114,187.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114,187.50
|
| Rate for Payer: Dean Health Medicaid |
$114,187.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$105,924.42
|
| Rate for Payer: Managed Health Services Medicaid |
$119,249.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$114,187.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$114,187.50
|
| Rate for Payer: United Healthcare Medicaid |
$114,187.50
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$206,932.12
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$183,810.02 |
| Max. Negotiated Rate |
$206,932.12 |
| Rate for Payer: Anthem Medicaid |
$198,148.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$198,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198,148.90
|
| Rate for Payer: Dean Health Medicaid |
$198,148.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$183,810.02
|
| Rate for Payer: Managed Health Services Medicaid |
$206,932.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$198,148.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$198,148.90
|
| Rate for Payer: United Healthcare Medicaid |
$198,148.90
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$162,038.37
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$143,932.59 |
| Max. Negotiated Rate |
$162,038.37 |
| Rate for Payer: Anthem Medicaid |
$155,160.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$155,160.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$155,160.67
|
| Rate for Payer: Dean Health Medicaid |
$155,160.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$143,932.59
|
| Rate for Payer: Managed Health Services Medicaid |
$162,038.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$155,160.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$155,160.67
|
| Rate for Payer: United Healthcare Medicaid |
$155,160.67
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$119,249.02
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$105,924.42 |
| Max. Negotiated Rate |
$119,249.02 |
| Rate for Payer: Anthem Medicaid |
$114,187.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$114,187.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114,187.50
|
| Rate for Payer: Dean Health Medicaid |
$114,187.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$105,924.42
|
| Rate for Payer: Managed Health Services Medicaid |
$119,249.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$114,187.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$114,187.50
|
| Rate for Payer: United Healthcare Medicaid |
$114,187.50
|
|
|
Implantable Loop Recorder 93291
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4294579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$288.50 |
| Rate for Payer: Aetna Commercial |
$288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$48.00
|
| Rate for Payer: Anthem Medicare Advantage |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.00
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$288.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$276.35
|
| Rate for Payer: HFN Commercial |
$288.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$71.99
|
| Rate for Payer: Preferred Network Access Commercial |
$288.50
|
| Rate for Payer: Quartz Beloit One Network |
$133.62
|
| Rate for Payer: Quartz Commercial |
$173.10
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$182.38
|
| Rate for Payer: United Healthcare Medicaid |
$40.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$191.98
|
|
|
Implantable Loop Recorder 9329126
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 93291 26
|
| Hospital Charge Code |
3219479
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$288.50 |
| Rate for Payer: Aetna Commercial |
$288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$17.61
|
| Rate for Payer: Anthem Medicare Advantage |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.61
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$288.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.61
|
| Rate for Payer: Health EOS Commercial |
$276.35
|
| Rate for Payer: HFN Commercial |
$288.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.41
|
| Rate for Payer: Preferred Network Access Commercial |
$288.50
|
| Rate for Payer: Quartz Beloit One Network |
$133.62
|
| Rate for Payer: Quartz Commercial |
$173.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.61
|
| Rate for Payer: The Alliance Commercial |
$66.91
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.61
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$70.43
|
|
|
Implantable Loop Recorder Data Analysis
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$204.52 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$48.00
|
| Rate for Payer: Anthem Medicare Advantage |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.00
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$71.99
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: Quartz Medicare Advantage |
$48.00
|
| Rate for Payer: The Alliance Commercial |
$182.38
|
| Rate for Payer: United Healthcare Medicaid |
$40.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$191.98
|
|
|
Implantable Loop Recorder Data Analysis
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
Implantable Loop Recorder Data Analysis
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.60
|
| Rate for Payer: Anthem Medicare Advantage |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.44
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.44
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.44
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$45.66
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$30.44
|
| Rate for Payer: The Alliance Commercial |
$121.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.44
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: Wellcare Medicare |
$30.44
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
Implantable Loop Recorder Data Analysis With Reprogramming
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
2982426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$374.05 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$458.02
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
Implantable Loop Recorder Data Analysis With Reprogramming
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
2982426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$702.29 |
| Rate for Payer: Aetna Commercial |
$687.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$656.49
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$496.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$366.41
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$702.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$679.39
|
| Rate for Payer: HFN Commercial |
$702.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$610.69
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$702.29
|
| Rate for Payer: Quartz Beloit One Network |
$374.05
|
| Rate for Payer: Quartz Commercial |
$496.18
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$419.85
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$565.40
|
|
|
Implantable Loop Recorder Data Analysis With Reprogramming
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
2982426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$59.30
|
| Rate for Payer: Anthem Medicare Advantage |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$88.95
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: Quartz Medicare Advantage |
$59.30
|
| Rate for Payer: The Alliance Commercial |
$225.34
|
| Rate for Payer: United Healthcare Medicaid |
$35.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$237.20
|
|
|
Implantation Intrastromal Corneal Ring 65785
|
Professional
|
Both
|
$7,271.00
|
|
|
Service Code
|
CPT 65785
|
| Hospital Charge Code |
4598876
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$382.89 |
| Max. Negotiated Rate |
$7,183.75 |
| Rate for Payer: Aetna Commercial |
$7,183.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,503.18
|
| Rate for Payer: Aetna Managed Medicare |
$382.89
|
| Rate for Payer: Anthem Medicare Advantage |
$382.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$382.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$382.89
|
| Rate for Payer: Cash Price |
$2,181.30
|
| Rate for Payer: Cash Price |
$2,181.30
|
| Rate for Payer: Cash Price |
$2,181.30
|
| Rate for Payer: Cigna Commercial |
$7,183.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,704.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.89
|
| Rate for Payer: Health EOS Commercial |
$6,881.27
|
| Rate for Payer: HFN Commercial |
$7,183.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,549.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,549.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$382.89
|
| Rate for Payer: Multiplan Commercial |
$6,049.47
|
| Rate for Payer: NAPHCARE Commercial |
$574.33
|
| Rate for Payer: Preferred Network Access Commercial |
$7,183.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,327.21
|
| Rate for Payer: Quartz Commercial |
$4,310.25
|
| Rate for Payer: Quartz Medicare Advantage |
$382.89
|
| Rate for Payer: The Alliance Commercial |
$1,627.27
|
| Rate for Payer: United Healthcare Medicaid |
$1,704.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.89
|
| Rate for Payer: WEA Trust Commercial |
$4,159.01
|
| Rate for Payer: WPS Commercial |
$1,722.99
|
|
|
IMPLANTATION OF ARTIFICIAL URINARY SPHINCTER
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
5404671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
IMPLANTATION OF ARTIFICIAL URINARY SPHINCTER
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
5404671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 64787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$768.64 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: The Alliance Commercial |
$768.64
|
|
