|
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
|
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
|
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
|
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 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 biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (i.e., breast, trunk) (list separately in addition to code for primary procedure)
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 15777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$687.07 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: The Alliance Commercial |
$687.07
|
|
|
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
|
|
|
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 |
$2,084.99 |
| Max. Negotiated Rate |
$6,850.69 |
| Rate for Payer: Aetna Commercial |
$6,701.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,403.90
|
| Rate for Payer: Aetna Managed Medicare |
$2,084.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,840.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,723.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,574.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.59
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cigna Commercial |
$6,850.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,167.12
|
| Rate for Payer: Health EOS Commercial |
$6,627.30
|
| Rate for Payer: HFN Commercial |
$6,850.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,584.80
|
| Rate for Payer: Multiplan Commercial |
$5,957.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,467.84
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.74
|
| Rate for Payer: Quartz Commercial |
$4,840.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4,467.84
|
| Rate for Payer: The Alliance Commercial |
$3,723.20
|
| Rate for Payer: WEA Trust Commercial |
$4,095.52
|
| Rate for Payer: WPS Commercial |
$5,515.35
|
|
|
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 |
$3,648.74 |
| Max. Negotiated Rate |
$6,850.69 |
| Rate for Payer: Aetna Commercial |
$6,701.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,403.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,946.59
|
| Rate for Payer: Cash Price |
$2,148.00
|
| Rate for Payer: Cigna Commercial |
$6,850.69
|
| Rate for Payer: Health EOS Commercial |
$6,627.30
|
| Rate for Payer: HFN Commercial |
$6,850.69
|
| Rate for Payer: Multiplan Commercial |
$5,957.12
|
| Rate for Payer: Preferred Network Access Commercial |
$6,850.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.74
|
| Rate for Payer: Quartz Commercial |
$4,467.84
|
| Rate for Payer: WEA Trust Commercial |
$4,095.52
|
| Rate for Payer: WPS Commercial |
$5,515.35
|
|
|
IMPLANT BREAST 286CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964631
|
|
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 BREAST 286CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964631
|
|
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 BREAST 371CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964632
|
|
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 BREAST 371CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964632
|
|
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 BREAST 421CC SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964633
|
|
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 BREAST 421CC SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964633
|
|
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 BREAST 575CC SILICONE
|
Facility
|
OP
|
$8,239.00
|
|
| Hospital Charge Code |
2964634
|
|
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 BREAST 575CC SILICONE
|
Facility
|
IP
|
$8,239.00
|
|
| Hospital Charge Code |
2964634
|
|
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 BREAST 700CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964635
|
|
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 BREAST 700CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964635
|
|
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 BREAST 752CC SILICONE
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967898
|
|
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 BREAST 752CC SILICONE
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967898
|
|
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 BREAST 800CC SILICON
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2964636
|
|
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 BREAST 800CC SILICON
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2964636
|
|
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 CHANDRAL DART 1.3 X 18MM AR-4005B-18
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5885643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.72 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$644.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.55
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.92
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,496.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.54
|
| Rate for Payer: The Alliance Commercial |
$1,151.28
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
