|
Immunoglobulins Quantitative
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Immunoglobulins Quantitative
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
Immunotherapy, Three Single Stinging Insect Venoms
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 95147
|
| Hospital Charge Code |
1190807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$219.24 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$2.53
|
| Rate for Payer: Anthem Medicare Advantage |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.53
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.53
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$3.79
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2.53
|
| Rate for Payer: The Alliance Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicaid |
$40.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.53
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$10.11
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
OP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.35 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Aetna Managed Medicare |
$564.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,310.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,007.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$967.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,127.92
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,511.64
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,209.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,310.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,209.31
|
| Rate for Payer: The Alliance Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
IP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.60 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,209.31
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
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 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 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
|
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 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 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
|
|
|
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
|
|
|
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
|
$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 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
|
$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 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
|
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
|
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
|
|
