|
ANNULOPLASTY RING 35MM DURAN 620BG35
|
Facility
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2970332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
ANNULOPLASTY RING 35MM DURAN #620RG35
|
Facility
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.24 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,493.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,416.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,931.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,856.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,828.24
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,151.50
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,931.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.20
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
ANNULOPLASTY RING 35MM DURAN #620RG35
|
Facility
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
OP
|
$39,231.04
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$39,231.04 |
| Rate for Payer: Aetna Managed Medicare |
$2,775.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,775.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,775.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,775.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,323.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,775.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,775.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,775.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,775.24
|
| Rate for Payer: NAPHCARE Commercial |
$4,162.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.24
|
| Rate for Payer: The Alliance Commercial |
$39,231.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,775.24
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,775.24
|
|
|
Anorectal Manometry
|
Professional
|
$920.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
1190818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.10 |
| Max. Negotiated Rate |
$1,060.16 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.20
|
| Rate for Payer: Aetna Managed Medicare |
$265.04
|
| Rate for Payer: Anthem Medicare Advantage |
$265.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.04
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$874.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$460.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.04
|
| Rate for Payer: Health EOS Commercial |
$837.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$930.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$930.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.04
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$874.00
|
| Rate for Payer: Quartz Beloit One Network |
$404.80
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: Quartz Medicare Advantage |
$265.04
|
| Rate for Payer: The Alliance Commercial |
$662.60
|
| Rate for Payer: United Healthcare Medicaid |
$210.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.04
|
| Rate for Payer: WEA Trust Commercial |
$506.00
|
| Rate for Payer: WPS Commercial |
$1,060.16
|
|
|
Anorectal Manometry 9112226
|
Professional
|
$920.00
|
|
|
Service Code
|
CPT 91122 26
|
| Hospital Charge Code |
3128860
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: Aetna Commercial |
$874.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.20
|
| Rate for Payer: Aetna Managed Medicare |
$83.90
|
| Rate for Payer: Anthem Medicare Advantage |
$83.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.90
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$874.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$460.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.90
|
| Rate for Payer: Health EOS Commercial |
$837.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.90
|
| Rate for Payer: Multiplan Commercial |
$736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$874.00
|
| Rate for Payer: Quartz Beloit One Network |
$404.80
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: Quartz Medicare Advantage |
$83.90
|
| Rate for Payer: The Alliance Commercial |
$209.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.90
|
| Rate for Payer: WEA Trust Commercial |
$506.00
|
| Rate for Payer: WPS Commercial |
$335.60
|
|
|
Anorectal Sensation 9112026
|
Professional
|
$490.00
|
|
|
Service Code
|
CPT 91120 26
|
| Hospital Charge Code |
3128872
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$465.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Aetna Managed Medicare |
$46.17
|
| Rate for Payer: Anthem Medicare Advantage |
$46.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.17
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$465.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.17
|
| Rate for Payer: Health EOS Commercial |
$445.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$167.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.17
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$465.50
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$279.30
|
| Rate for Payer: Quartz Medicare Advantage |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$115.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.17
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$184.68
|
|
|
ANOSCOPY 46615
|
Professional
|
$1,592.00
|
|
|
Service Code
|
CPT 46615
|
| Hospital Charge Code |
3014844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$1,512.40 |
| Rate for Payer: Aetna Commercial |
$1,512.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.12
|
| Rate for Payer: Aetna Managed Medicare |
$84.40
|
| Rate for Payer: Anthem Medicare Advantage |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.40
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,512.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.40
|
| Rate for Payer: Health EOS Commercial |
$1,448.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$304.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.40
|
| Rate for Payer: Multiplan Commercial |
$1,273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.40
|
| Rate for Payer: Quartz Beloit One Network |
$700.48
|
| Rate for Payer: Quartz Commercial |
$907.44
|
| Rate for Payer: Quartz Medicare Advantage |
$84.40
|
| Rate for Payer: The Alliance Commercial |
$358.70
|
| Rate for Payer: United Healthcare Medicaid |
$207.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.40
|
| Rate for Payer: WEA Trust Commercial |
$875.60
|
| Rate for Payer: WPS Commercial |
$379.80
|
|
|
ANOSCOPY AND BIOPSY 46606
|
Professional
|
$571.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
3014842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna Commercial |
$542.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Aetna Managed Medicare |
$69.51
|
| Rate for Payer: Anthem Medicare Advantage |
$69.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.51
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$542.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.51
|
| Rate for Payer: Health EOS Commercial |
$519.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$248.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.51
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Preferred Network Access Commercial |
$542.45
|
| Rate for Payer: Quartz Beloit One Network |
$251.24
|
| Rate for Payer: Quartz Commercial |
$325.47
|
| Rate for Payer: Quartz Medicare Advantage |
$69.51
|
| Rate for Payer: The Alliance Commercial |
$295.42
|
| Rate for Payer: United Healthcare Medicaid |
$44.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.51
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$312.80
|
|
|
ANOSCOPY AND DILATION 46604
|
Professional
|
$1,242.00
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
3014841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Aetna Commercial |
$1,179.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$60.96
|
| Rate for Payer: Anthem Medicare Advantage |
$60.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.96
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,179.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$621.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.96
|
| Rate for Payer: Health EOS Commercial |
$1,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$216.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.90
|
| Rate for Payer: Quartz Beloit One Network |
$546.48
|
| Rate for Payer: Quartz Commercial |
$707.94
|
| Rate for Payer: Quartz Medicare Advantage |
$60.96
|
| Rate for Payer: The Alliance Commercial |
$259.08
|
| Rate for Payer: United Healthcare Medicaid |
$37.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.96
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$274.32
|
|
|
Anoscopy Diagnostic With Or Without Collection Of Specimen 46600
|
Professional
|
$268.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
1188850
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Aetna Managed Medicare |
$38.37
|
| Rate for Payer: Anthem Medicare Advantage |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.37
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$254.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.37
|
| Rate for Payer: Health EOS Commercial |
$243.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$254.60
|
| Rate for Payer: Quartz Beloit One Network |
$117.92
|
| Rate for Payer: Quartz Commercial |
$152.76
|
| Rate for Payer: Quartz Medicare Advantage |
$38.37
|
| Rate for Payer: The Alliance Commercial |
$163.07
|
| Rate for Payer: United Healthcare Medicaid |
$31.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$172.66
|
|
|
ANOSCOPY, REMOVE LESIONS 46612
|
Professional
|
$891.00
|
|
|
Service Code
|
CPT 46612
|
| Hospital Charge Code |
3014843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Aetna Commercial |
$846.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Aetna Managed Medicare |
$85.35
|
| Rate for Payer: Anthem Medicare Advantage |
$85.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.35
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$846.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$445.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.35
|
| Rate for Payer: Health EOS Commercial |
$810.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$306.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.35
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: Preferred Network Access Commercial |
$846.45
|
| Rate for Payer: Quartz Beloit One Network |
$392.04
|
| Rate for Payer: Quartz Commercial |
$507.87
|
| Rate for Payer: Quartz Medicare Advantage |
$85.35
|
| Rate for Payer: The Alliance Commercial |
$362.74
|
| Rate for Payer: United Healthcare Medicaid |
$59.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.35
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: WPS Commercial |
$384.08
|
|
|
ANTENNA PATIENT PROGRAMMER INTERSTIM 37092
|
Facility
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349495
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$409.36 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| Rate for Payer: Aetna Managed Medicare |
$409.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$950.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.14
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$950.30
|
| Rate for Payer: Quartz Medicare Advantage |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
ANTENNA PATIENT PROGRAMMER INTERSTIM 37092
|
Facility
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349495
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$716.38 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED
|
Facility
OP
|
$25,387.88
|
|
|
Service Code
|
CPT 57240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$25,387.88 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$25,387.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
ANTERIOR COLPORRPHAPY
|
Facility
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ANTERIOR COLPORRPHAPY
|
Facility
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ANTERIOR CRUCIATE LIG RECON W/HAMSTRING
|
Facility
OP
|
$8,979.00
|
|
| Hospital Charge Code |
2959778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,514.12 |
| Max. Negotiated Rate |
$35,916.00 |
| Rate for Payer: Aetna Commercial |
$8,081.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,721.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,514.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,836.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,489.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,309.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,758.87
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,260.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,024.65
|
| Rate for Payer: Health EOS Commercial |
$7,991.31
|
| Rate for Payer: HFN Commercial |
$8,260.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,734.25
|
| Rate for Payer: Multiplan Commercial |
$7,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,260.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,399.71
|
| Rate for Payer: Quartz Commercial |
$5,836.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,387.40
|
| Rate for Payer: The Alliance Commercial |
$35,916.00
|
| Rate for Payer: WEA Trust Commercial |
$4,938.45
|
| Rate for Payer: WPS Commercial |
$6,650.75
|
|
|
ANTERIOR CRUCIATE LIG RECON W/HAMSTRING
|
Facility
IP
|
$8,979.00
|
|
| Hospital Charge Code |
2959778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,399.71 |
| Max. Negotiated Rate |
$8,260.68 |
| Rate for Payer: Aetna Commercial |
$8,081.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,758.87
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,260.68
|
| Rate for Payer: Health EOS Commercial |
$7,991.31
|
| Rate for Payer: HFN Commercial |
$8,260.68
|
| Rate for Payer: Multiplan Commercial |
$7,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,260.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,399.71
|
| Rate for Payer: Quartz Commercial |
$5,387.40
|
| Rate for Payer: WEA Trust Commercial |
$4,938.45
|
| Rate for Payer: WPS Commercial |
$6,650.75
|
|
|
ANTERIOR CRUCIATE LIG W/BONE TENDON BONE
|
Facility
OP
|
$8,979.00
|
|
| Hospital Charge Code |
2959777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,514.12 |
| Max. Negotiated Rate |
$35,916.00 |
| Rate for Payer: Aetna Commercial |
$8,081.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,721.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,514.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,836.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,489.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,309.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,758.87
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,260.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,024.65
|
| Rate for Payer: Health EOS Commercial |
$7,991.31
|
| Rate for Payer: HFN Commercial |
$8,260.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,734.25
|
| Rate for Payer: Multiplan Commercial |
$7,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,260.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,399.71
|
| Rate for Payer: Quartz Commercial |
$5,836.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,387.40
|
| Rate for Payer: The Alliance Commercial |
$35,916.00
|
| Rate for Payer: WEA Trust Commercial |
$4,938.45
|
| Rate for Payer: WPS Commercial |
$6,650.75
|
|
|
ANTERIOR CRUCIATE LIG W/BONE TENDON BONE
|
Facility
IP
|
$8,979.00
|
|
| Hospital Charge Code |
2959777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,399.71 |
| Max. Negotiated Rate |
$8,260.68 |
| Rate for Payer: Aetna Commercial |
$8,081.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,758.87
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,260.68
|
| Rate for Payer: Health EOS Commercial |
$7,991.31
|
| Rate for Payer: HFN Commercial |
$8,260.68
|
| Rate for Payer: Multiplan Commercial |
$7,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,387.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,260.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,399.71
|
| Rate for Payer: Quartz Commercial |
$5,387.40
|
| Rate for Payer: WEA Trust Commercial |
$4,938.45
|
| Rate for Payer: WPS Commercial |
$6,650.75
|
|
|
ANTERIOR POSTERIOR/RECTOCELE REPAIR
|
Facility
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ANTERIOR POSTERIOR/RECTOCELE REPAIR
|
Facility
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 27418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,546.14 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
AntibioticPocket ICD
|
Professional
|
$7,927.00
|
|
| Hospital Charge Code |
2549042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,487.88 |
| Max. Negotiated Rate |
$7,530.65 |
| Rate for Payer: Aetna Commercial |
$7,530.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,817.22
|
| Rate for Payer: Cash Price |
$2,378.10
|
| Rate for Payer: Cigna Commercial |
$7,530.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,756.20
|
| Rate for Payer: Health EOS Commercial |
$7,213.57
|
| Rate for Payer: Multiplan Commercial |
$6,341.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,530.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,487.88
|
| Rate for Payer: Quartz Commercial |
$4,518.39
|
| Rate for Payer: The Alliance Commercial |
$3,963.50
|
| Rate for Payer: WEA Trust Commercial |
$4,359.85
|
| Rate for Payer: WPS Commercial |
$5,871.53
|
|
