|
IMPLANT 42MM GLENOID SYNTHES
|
Facility
|
OP
|
$6,804.00
|
|
| Hospital Charge Code |
2966259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,905.12 |
| Max. Negotiated Rate |
$27,216.00 |
| Rate for Payer: Aetna Commercial |
$6,123.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,851.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,905.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,422.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,402.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,265.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,606.12
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,259.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,807.52
|
| Rate for Payer: Health EOS Commercial |
$6,055.56
|
| Rate for Payer: HFN Commercial |
$6,259.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,103.00
|
| Rate for Payer: Multiplan Commercial |
$5,443.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,259.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,333.96
|
| Rate for Payer: Quartz Commercial |
$4,422.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,082.40
|
| Rate for Payer: The Alliance Commercial |
$27,216.00
|
| Rate for Payer: WEA Trust Commercial |
$3,742.20
|
| Rate for Payer: WPS Commercial |
$5,039.72
|
|
|
IMPLANT 550CC PROFILE SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,037.11 |
| Max. Negotiated Rate |
$7,579.88 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$4,943.40
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT 550CC PROFILE SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.92 |
| Max. Negotiated Rate |
$32,956.00 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,355.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,610.54
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,179.25
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$5,355.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,943.40
|
| Rate for Payer: The Alliance Commercial |
$32,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT 650CC PROFILE SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.92 |
| Max. Negotiated Rate |
$32,956.00 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,355.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,610.54
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,179.25
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$5,355.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,943.40
|
| Rate for Payer: The Alliance Commercial |
$32,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANT 650CC PROFILE SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,037.11 |
| Max. Negotiated Rate |
$7,579.88 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$4,943.40
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
|
IMPLANTABLE CARDIOVASCULAR MONITOR SYSTEM 93290
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 93290
|
| Hospital Charge Code |
3015363
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| 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 |
$281.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.60
|
| Rate for Payer: Health EOS Commercial |
$269.36
|
| Rate for Payer: HFN Commercial |
$281.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.19
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Preferred Network Access Commercial |
$281.20
|
| Rate for Payer: Quartz Beloit One Network |
$130.24
|
| Rate for Payer: Quartz Commercial |
$168.72
|
| Rate for Payer: The Alliance Commercial |
$148.00
|
| Rate for Payer: United Healthcare Medicaid |
$23.74
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Implantable Loop Recorder 93291
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4294579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna Commercial |
$277.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| 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 |
$277.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.20
|
| Rate for Payer: Health EOS Commercial |
$265.72
|
| Rate for Payer: HFN Commercial |
$277.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$277.40
|
| Rate for Payer: Quartz Beloit One Network |
$128.48
|
| Rate for Payer: Quartz Commercial |
$166.44
|
| Rate for Payer: The Alliance Commercial |
$146.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
Implantable Loop Recorder 9329126
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 93291 26
|
| Hospital Charge Code |
3219479
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna Commercial |
$277.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| 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 |
$277.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.20
|
| Rate for Payer: Health EOS Commercial |
$265.72
|
| Rate for Payer: HFN Commercial |
$277.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.33
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$277.40
|
| Rate for Payer: Quartz Beloit One Network |
$128.48
|
| Rate for Payer: Quartz Commercial |
$166.44
|
| Rate for Payer: The Alliance Commercial |
$146.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
Implantable Loop Recorder Data Analysis
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
Implantable Loop Recorder Data Analysis
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$196.65 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| 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 |
$196.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$188.37
|
| Rate for Payer: HFN Commercial |
$196.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.65
|
| Rate for Payer: Quartz Beloit One Network |
$91.08
|
| Rate for Payer: Quartz Commercial |
$117.99
|
| Rate for Payer: The Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Medicaid |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
Implantable Loop Recorder Data Analysis
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
2982425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$29.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$321.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$237.12
|
| Rate for Payer: Anthem Medicare Advantage |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.43
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.43
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.14
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$29.43
|
| Rate for Payer: The Alliance Commercial |
$117.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.43
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: Wellcare Medicare |
$29.43
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
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 |
$34.35 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| 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 |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.06
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: United Healthcare Medicaid |
$34.35
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
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 |
$37.27 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.32
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$477.10
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
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 |
$359.66 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$660.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.02
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cigna Commercial |
$675.28
|
| Rate for Payer: Health EOS Commercial |
$653.26
|
| Rate for Payer: HFN Commercial |
$675.28
|
| Rate for Payer: Multiplan Commercial |
$587.20
|
| Rate for Payer: NAPHCARE Commercial |
$440.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.28
|
| Rate for Payer: Quartz Beloit One Network |
$359.66
|
| Rate for Payer: Quartz Commercial |
$440.40
|
| Rate for Payer: WEA Trust Commercial |
$403.70
|
| Rate for Payer: WPS Commercial |
$543.67
|
|
|
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 |
$1,490.26 |
| Max. Negotiated Rate |
$6,907.45 |
| Rate for Payer: Aetna Commercial |
$6,907.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,253.06
|
| 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 |
$6,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,639.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,362.60
|
| Rate for Payer: Health EOS Commercial |
$6,616.61
|
| Rate for Payer: HFN Commercial |
$6,907.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,490.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,490.26
|
| Rate for Payer: Multiplan Commercial |
$5,816.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,907.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,199.24
|
| Rate for Payer: Quartz Commercial |
$4,144.47
|
| Rate for Payer: The Alliance Commercial |
$3,635.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,639.30
|
| Rate for Payer: WEA Trust Commercial |
$3,999.05
|
| Rate for Payer: WPS Commercial |
$5,385.63
|
|
|
IMPLANTATION OF ARTIFICIAL URINARY SPHINCTER
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
5404671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
IMPLANTATION OF ARTIFICIAL URINARY SPHINCTER
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
5404671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 64787
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,757.59 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
|
|
IMPLANT BIOCARTILAGE 1CC ABS-1010-BC
|
Facility
|
IP
|
$7,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5240721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.40 |
| Max. Negotiated Rate |
$6,587.20 |
| Rate for Payer: Aetna Commercial |
$6,444.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,157.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,794.80
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cigna Commercial |
$6,587.20
|
| Rate for Payer: Health EOS Commercial |
$6,372.40
|
| Rate for Payer: HFN Commercial |
$6,587.20
|
| Rate for Payer: Multiplan Commercial |
$5,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,587.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,508.40
|
| Rate for Payer: Quartz Commercial |
$4,296.00
|
| Rate for Payer: WEA Trust Commercial |
$3,938.00
|
| Rate for Payer: WPS Commercial |
$5,303.41
|
|
|
IMPLANT BIOCARTILAGE 1CC ABS-1010-BC
|
Facility
|
OP
|
$7,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5240721
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.80 |
| Max. Negotiated Rate |
$28,640.00 |
| Rate for Payer: Aetna Commercial |
$6,444.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,157.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,004.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,654.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,580.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,436.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,794.80
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cigna Commercial |
$6,587.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,006.74
|
| Rate for Payer: Health EOS Commercial |
$6,372.40
|
| Rate for Payer: HFN Commercial |
$6,587.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,370.00
|
| Rate for Payer: Multiplan Commercial |
$5,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,587.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,508.40
|
| Rate for Payer: Quartz Commercial |
$4,654.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,296.00
|
| Rate for Payer: The Alliance Commercial |
$28,640.00
|
| Rate for Payer: WEA Trust Commercial |
$3,938.00
|
| Rate for Payer: WPS Commercial |
$5,303.41
|
|
|
IMPLANT BREAST 286CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964631
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
IMPLANT BREAST 286CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964631
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
IMPLANT BREAST 371CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964632
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
IMPLANT BREAST 371CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964632
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
IMPLANT BREAST 421CC SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.92 |
| Max. Negotiated Rate |
$32,956.00 |
| Rate for Payer: Aetna Commercial |
$7,415.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,355.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.67
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cigna Commercial |
$7,579.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,610.54
|
| Rate for Payer: Health EOS Commercial |
$7,332.71
|
| Rate for Payer: HFN Commercial |
$7,579.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,179.25
|
| Rate for Payer: Multiplan Commercial |
$6,591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,943.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.11
|
| Rate for Payer: Quartz Commercial |
$5,355.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,943.40
|
| Rate for Payer: The Alliance Commercial |
$32,956.00
|
| Rate for Payer: WEA Trust Commercial |
$4,531.45
|
| Rate for Payer: WPS Commercial |
$6,102.63
|
|
