|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Professional
|
Both
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.38
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Facility
|
IP
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$306.38
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MANIFOLD NEPTUNE 4-PORT 0702-020-000
|
Facility
|
OP
|
$491.00
|
|
| Hospital Charge Code |
4595080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$142.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.76
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.98
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$306.38
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$331.92
|
| Rate for Payer: Quartz Medicare Advantage |
$306.38
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.40
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| 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: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
MANIFOLD NEPTUNE SINGLE PORT 0702-025-000
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
4595058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Maniplatn Palar Fascial Crd Post Inj 26341
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
CPT 26341
|
| Hospital Charge Code |
4340593
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.34 |
| Max. Negotiated Rate |
$883.27 |
| Rate for Payer: Aetna Commercial |
$883.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$799.59
|
| Rate for Payer: Aetna Managed Medicare |
$70.34
|
| Rate for Payer: Anthem Medicare Advantage |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.34
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cash Price |
$268.20
|
| Rate for Payer: Cigna Commercial |
$883.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.34
|
| Rate for Payer: Health EOS Commercial |
$846.08
|
| Rate for Payer: HFN Commercial |
$883.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$268.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.34
|
| Rate for Payer: Multiplan Commercial |
$743.81
|
| Rate for Payer: NAPHCARE Commercial |
$105.50
|
| Rate for Payer: Preferred Network Access Commercial |
$883.27
|
| Rate for Payer: Quartz Beloit One Network |
$409.09
|
| Rate for Payer: Quartz Commercial |
$529.96
|
| Rate for Payer: Quartz Medicare Advantage |
$70.34
|
| Rate for Payer: The Alliance Commercial |
$298.92
|
| Rate for Payer: United Healthcare Medicaid |
$77.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.34
|
| Rate for Payer: WEA Trust Commercial |
$511.37
|
| Rate for Payer: WPS Commercial |
$316.51
|
|
|
MANIPULATION, ANKLE/FOOT/HIP/KNEE/SHOULDER/WRIST
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
MANIPULATION, ANKLE/FOOT/HIP/KNEE/SHOULDER/WRIST
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
MANIPULATOR INJECTOR UTERINE KRONNER MANIPUJECTOR 6003
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
2964989
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$282.36
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
MANIPULATOR INJECTOR UTERINE KRONNER MANIPUJECTOR 6003
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
2964989
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
MANIPULATOR VCARE PLUS UTERINE LARGE CUP 37MM 60-6085-202A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.94 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,328.50
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANIPULATOR VCARE PLUS UTERINE LARGE CUP 37MM 60-6085-202A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.96 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Aetna Managed Medicare |
$619.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.08
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.62
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,439.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.50
|
| Rate for Payer: The Alliance Commercial |
$1,107.08
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANIPULATOR VCARE PLUS UTERINE MEDIUM CUP 34MM 60-6085-201A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.96 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Aetna Managed Medicare |
$619.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.08
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.62
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,439.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.50
|
| Rate for Payer: The Alliance Commercial |
$1,107.08
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANIPULATOR VCARE PLUS UTERINE MEDIUM CUP 34MM 60-6085-201A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.94 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,328.50
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANIPULATOR VCARE PLUS UTERINE SMALL CUP 32MM 60-6085-200A
|
Facility
|
IP
|
$2,129.00
|
|
| Hospital Charge Code |
5264650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,084.94 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,328.50
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANIPULATOR VCARE PLUS UTERINE SMALL CUP 32MM 60-6085-200A
|
Facility
|
OP
|
$2,129.00
|
|
| Hospital Charge Code |
5264650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$619.96 |
| Max. Negotiated Rate |
$2,037.03 |
| Rate for Payer: Aetna Commercial |
$1,992.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Aetna Managed Medicare |
$619.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.50
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,037.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,239.08
|
| Rate for Payer: Health EOS Commercial |
$1,970.60
|
| Rate for Payer: HFN Commercial |
$2,037.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.62
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.94
|
| Rate for Payer: Quartz Commercial |
$1,439.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.50
|
| Rate for Payer: The Alliance Commercial |
$1,107.08
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$1,639.97
|
|
|
MANOMETER PRESSURE DISP #6098DPG
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
2974773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
MANOMETER PRESSURE DISP #6098DPG
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
2974773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
.Manual Differential
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$5.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$17.39
|
|
|
.Manual Differential
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$5.93
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
.Manual Differential
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Manual Irrigation of a pre-existing catheter* - Urinary Catheter Activity Type:
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
5582049
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.28
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$189.96
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$219.18
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
