|
Inpatient Hemodialysis
|
Facility
|
IP
|
$1,950.00
|
|
| Hospital Charge Code |
3005578
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$993.72 |
| Max. Negotiated Rate |
$1,865.76 |
| Rate for Payer: Aetna Commercial |
$1,825.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.84
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,865.76
|
| Rate for Payer: Health EOS Commercial |
$1,804.92
|
| Rate for Payer: HFN Commercial |
$1,865.76
|
| Rate for Payer: Multiplan Commercial |
$1,622.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.76
|
| Rate for Payer: Quartz Beloit One Network |
$993.72
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: WEA Trust Commercial |
$1,115.40
|
| Rate for Payer: WPS Commercial |
$1,502.09
|
|
|
Inpatient Lumbar Puncture
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
2952003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$587.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$561.68
|
| Rate for Payer: Aetna Managed Medicare |
$742.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$424.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$313.50
|
| Rate for Payer: Anthem Medicare Advantage |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$600.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$742.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$742.86
|
| Rate for Payer: Health EOS Commercial |
$581.28
|
| Rate for Payer: HFN Commercial |
$600.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,763.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$742.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$742.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$742.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$742.86
|
| Rate for Payer: Multiplan Commercial |
$522.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.29
|
| Rate for Payer: Preferred Network Access Commercial |
$600.87
|
| Rate for Payer: Quartz Beloit One Network |
$320.03
|
| Rate for Payer: Quartz Commercial |
$424.53
|
| Rate for Payer: Quartz Medicare Advantage |
$742.86
|
| Rate for Payer: The Alliance Commercial |
$2,971.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.86
|
| Rate for Payer: United Healthcare PPO |
$489.84
|
| Rate for Payer: WEA Trust Commercial |
$359.22
|
| Rate for Payer: Wellcare Medicare |
$742.86
|
| Rate for Payer: WPS Commercial |
$483.75
|
|
|
Inpatient Lumbar Puncture
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
2952003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$320.03 |
| Max. Negotiated Rate |
$600.87 |
| Rate for Payer: Aetna Commercial |
$587.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$561.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$346.15
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cigna Commercial |
$600.87
|
| Rate for Payer: Health EOS Commercial |
$581.28
|
| Rate for Payer: HFN Commercial |
$600.87
|
| Rate for Payer: Multiplan Commercial |
$522.50
|
| Rate for Payer: Preferred Network Access Commercial |
$600.87
|
| Rate for Payer: Quartz Beloit One Network |
$320.03
|
| Rate for Payer: Quartz Commercial |
$391.87
|
| Rate for Payer: WEA Trust Commercial |
$359.22
|
| Rate for Payer: WPS Commercial |
$483.75
|
|
|
Inpt Consult Brief
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
3040423
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Inpt Consult Brief
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 99252
|
| Hospital Charge Code |
3040423
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Inpt Consult Extended
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
3040425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.18 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$123.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.19
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.94
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$263.95
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$285.95
|
| Rate for Payer: Quartz Medicare Advantage |
$263.95
|
| Rate for Payer: The Alliance Commercial |
$219.96
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
Inpt Consult Extended
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 99254
|
| Hospital Charge Code |
3040425
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.56 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$263.95
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
Inpt Consult Routine
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
3040424
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$101.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.44
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$217.15
|
| Rate for Payer: The Alliance Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Inpt Consult Routine
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 99253
|
| Hospital Charge Code |
3040424
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
INSERT AND REMOVE BONE PIN 20650
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
3013707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$693.25 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$154.06
|
| Rate for Payer: Anthem Medicare Advantage |
$154.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.06
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.06
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$550.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.06
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$231.08
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$154.06
|
| Rate for Payer: The Alliance Commercial |
$654.73
|
| Rate for Payer: United Healthcare Medicaid |
$103.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.06
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$693.25
|
|
|
INSERT AS TIBIAL BEARING DCM ARCOM VANGUARD 12MM X 71MM 189062
|
Facility
|
IP
|
$5,053.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.01 |
| Max. Negotiated Rate |
$4,834.71 |
| Rate for Payer: Aetna Commercial |
$4,729.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,519.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.21
|
| Rate for Payer: Cash Price |
$1,515.90
|
| Rate for Payer: Cigna Commercial |
$4,834.71
|
| Rate for Payer: Health EOS Commercial |
$4,677.06
|
| Rate for Payer: HFN Commercial |
$4,834.71
|
| Rate for Payer: Multiplan Commercial |
$4,204.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,575.01
|
| Rate for Payer: Quartz Commercial |
$3,153.07
|
| Rate for Payer: WEA Trust Commercial |
$2,890.32
|
| Rate for Payer: WPS Commercial |
$3,892.33
|
|
|
INSERT AS TIBIAL BEARING DCM ARCOM VANGUARD 12MM X 71MM 189062
|
Facility
|
OP
|
$5,053.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6170218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.43 |
| Max. Negotiated Rate |
$4,834.71 |
| Rate for Payer: Aetna Commercial |
$4,729.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,519.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,415.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,627.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,522.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,785.21
|
| Rate for Payer: Cash Price |
$1,515.90
|
| Rate for Payer: Cigna Commercial |
$4,834.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,940.85
|
| Rate for Payer: Health EOS Commercial |
$4,677.06
|
| Rate for Payer: HFN Commercial |
$4,834.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,941.34
|
| Rate for Payer: Multiplan Commercial |
$4,204.10
|
| Rate for Payer: NAPHCARE Commercial |
$3,153.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,834.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,575.01
|
| Rate for Payer: Quartz Commercial |
$3,415.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,153.07
|
| Rate for Payer: The Alliance Commercial |
$2,627.56
|
| Rate for Payer: WEA Trust Commercial |
$2,890.32
|
| Rate for Payer: WPS Commercial |
$3,892.33
|
|
|
Insert Bladder Cath 51703
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
3137481
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$65.02
|
| Rate for Payer: Anthem Medicare Advantage |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.02
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.02
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.02
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$97.53
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$65.02
|
| Rate for Payer: The Alliance Commercial |
$276.34
|
| Rate for Payer: United Healthcare Medicaid |
$146.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.02
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$292.59
|
|
|
Insert Bladder Catheter 5170150
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 51701 50
|
| Hospital Charge Code |
3970701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.79 |
| Max. Negotiated Rate |
$665.91 |
| Rate for Payer: Aetna Commercial |
$665.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$665.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.58
|
| Rate for Payer: Health EOS Commercial |
$637.87
|
| Rate for Payer: HFN Commercial |
$665.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.04
|
| Rate for Payer: Multiplan Commercial |
$560.77
|
| Rate for Payer: Preferred Network Access Commercial |
$665.91
|
| Rate for Payer: Quartz Beloit One Network |
$308.42
|
| Rate for Payer: Quartz Commercial |
$399.55
|
| Rate for Payer: The Alliance Commercial |
$350.48
|
| Rate for Payer: United Healthcare Medicaid |
$59.79
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
|
Insert Bladder Catheter 51701PP
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3529570
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$21.10
|
| Rate for Payer: Anthem Medicare Advantage |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.10
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$31.65
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$21.10
|
| Rate for Payer: The Alliance Commercial |
$89.68
|
| Rate for Payer: United Healthcare Medicaid |
$59.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.10
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$94.96
|
|
|
INSERT CERAMIC NEUTRAL 52MM 36MM 1218-87-652
|
Facility
|
IP
|
$14,361.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,318.37 |
| Max. Negotiated Rate |
$13,740.60 |
| Rate for Payer: Aetna Commercial |
$13,441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,844.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.78
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna Commercial |
$13,740.60
|
| Rate for Payer: Health EOS Commercial |
$13,292.54
|
| Rate for Payer: HFN Commercial |
$13,740.60
|
| Rate for Payer: Multiplan Commercial |
$11,948.35
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.37
|
| Rate for Payer: Quartz Commercial |
$8,961.26
|
| Rate for Payer: WEA Trust Commercial |
$8,214.49
|
| Rate for Payer: WPS Commercial |
$11,062.28
|
|
|
INSERT CERAMIC NEUTRAL 52MM 36MM 1218-87-652
|
Facility
|
OP
|
$14,361.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.92 |
| Max. Negotiated Rate |
$13,740.60 |
| Rate for Payer: Aetna Commercial |
$13,441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,844.48
|
| Rate for Payer: Aetna Managed Medicare |
$4,181.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,708.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,467.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,169.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,915.78
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna Commercial |
$13,740.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,358.10
|
| Rate for Payer: Health EOS Commercial |
$13,292.54
|
| Rate for Payer: HFN Commercial |
$13,740.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,201.58
|
| Rate for Payer: Multiplan Commercial |
$11,948.35
|
| Rate for Payer: NAPHCARE Commercial |
$8,961.26
|
| Rate for Payer: Preferred Network Access Commercial |
$13,740.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,318.37
|
| Rate for Payer: Quartz Commercial |
$9,708.04
|
| Rate for Payer: Quartz Medicare Advantage |
$8,961.26
|
| Rate for Payer: The Alliance Commercial |
$7,467.72
|
| Rate for Payer: WEA Trust Commercial |
$8,214.49
|
| Rate for Payer: WPS Commercial |
$11,062.28
|
|
|
INSERT COMPREHENSIVE REVERSE SHOULDER VIVACIT-E POLYETHYLENE BEARING +3 36MM 110031426
|
Facility
|
IP
|
$8,759.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,463.59 |
| Max. Negotiated Rate |
$8,380.61 |
| Rate for Payer: Aetna Commercial |
$8,198.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,834.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,827.96
|
| Rate for Payer: Cash Price |
$2,627.70
|
| Rate for Payer: Cigna Commercial |
$8,380.61
|
| Rate for Payer: Health EOS Commercial |
$8,107.33
|
| Rate for Payer: HFN Commercial |
$8,380.61
|
| Rate for Payer: Multiplan Commercial |
$7,287.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8,380.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,463.59
|
| Rate for Payer: Quartz Commercial |
$5,465.62
|
| Rate for Payer: WEA Trust Commercial |
$5,010.15
|
| Rate for Payer: WPS Commercial |
$6,747.06
|
|
|
INSERT COMPREHENSIVE REVERSE SHOULDER VIVACIT-E POLYETHYLENE BEARING +3 36MM 110031426
|
Facility
|
OP
|
$8,759.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6165992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,550.62 |
| Max. Negotiated Rate |
$8,380.61 |
| Rate for Payer: Aetna Commercial |
$8,198.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,834.05
|
| Rate for Payer: Aetna Managed Medicare |
$2,550.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,921.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,554.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,372.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,827.96
|
| Rate for Payer: Cash Price |
$2,627.70
|
| Rate for Payer: Cigna Commercial |
$8,380.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,097.74
|
| Rate for Payer: Health EOS Commercial |
$8,107.33
|
| Rate for Payer: HFN Commercial |
$8,380.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,832.02
|
| Rate for Payer: Multiplan Commercial |
$7,287.49
|
| Rate for Payer: NAPHCARE Commercial |
$5,465.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8,380.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,463.59
|
| Rate for Payer: Quartz Commercial |
$5,921.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5,465.62
|
| Rate for Payer: The Alliance Commercial |
$4,554.68
|
| Rate for Payer: WEA Trust Commercial |
$5,010.15
|
| Rate for Payer: WPS Commercial |
$6,747.06
|
|
|
Inserted - Chest Tube Activity:
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$786.82 |
| Max. Negotiated Rate |
$1,477.30 |
| Rate for Payer: Aetna Commercial |
$1,445.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.05
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: Health EOS Commercial |
$1,429.13
|
| Rate for Payer: HFN Commercial |
$1,477.30
|
| Rate for Payer: Multiplan Commercial |
$1,284.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.30
|
| Rate for Payer: Quartz Beloit One Network |
$786.82
|
| Rate for Payer: Quartz Commercial |
$963.46
|
| Rate for Payer: WEA Trust Commercial |
$883.17
|
| Rate for Payer: WPS Commercial |
$1,189.34
|
|
|
Inserted - Chest Tube Activity:
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
3000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$1,445.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,043.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$802.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$770.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$851.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cigna Commercial |
$1,477.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$1,429.13
|
| Rate for Payer: HFN Commercial |
$1,477.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$1,284.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,477.30
|
| Rate for Payer: Quartz Beloit One Network |
$786.82
|
| Rate for Payer: Quartz Commercial |
$1,043.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$883.17
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,189.34
|
|
|
Inserted - Enteral Tube Activity
|
Facility
|
OP
|
$177.00
|
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$51.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.01
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.06
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$110.45
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.45
|
| Rate for Payer: The Alliance Commercial |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
Inserted - Enteral Tube Activity
|
Facility
|
IP
|
$177.00
|
|
| Hospital Charge Code |
3000025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
INSERTER COOK MEDICAL G55179
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
INSERTER COOK MEDICAL G55179
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
4641053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
