|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$183,976.00
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$66,178.50 |
| Max. Negotiated Rate |
$183,976.00 |
| Rate for Payer: Aetna Managed Medicare |
$66,178.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144,971.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111,119.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105,570.98
|
| Rate for Payer: Anthem Medicare Advantage |
$66,178.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66,178.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66,178.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66,178.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117,193.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66,178.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134,706.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66,178.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66,178.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66,178.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66,178.50
|
| Rate for Payer: NAPHCARE Commercial |
$99,267.75
|
| Rate for Payer: Quartz Medicare Advantage |
$66,178.50
|
| Rate for Payer: The Alliance Commercial |
$183,976.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66,178.50
|
| Rate for Payer: United Healthcare PPO |
$104,870.35
|
| Rate for Payer: Wellcare Medicare |
$66,178.50
|
|
|
RESPONSE BOOKLET 1 WAIS IV
|
Facility
|
OP
|
$1,354.00
|
|
| Hospital Charge Code |
2972200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$379.12 |
| Max. Negotiated Rate |
$5,416.00 |
| Rate for Payer: Aetna Commercial |
$1,218.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.44
|
| Rate for Payer: Aetna Managed Medicare |
$379.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.62
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,245.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$757.70
|
| Rate for Payer: Health EOS Commercial |
$1,205.06
|
| Rate for Payer: HFN Commercial |
$1,245.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,015.50
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$812.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.68
|
| Rate for Payer: Quartz Beloit One Network |
$663.46
|
| Rate for Payer: Quartz Commercial |
$880.10
|
| Rate for Payer: Quartz Medicare Advantage |
$812.40
|
| Rate for Payer: The Alliance Commercial |
$5,416.00
|
| Rate for Payer: WEA Trust Commercial |
$744.70
|
| Rate for Payer: WPS Commercial |
$1,002.91
|
|
|
RESPONSE BOOKLET 1 WAIS IV
|
Facility
|
IP
|
$1,354.00
|
|
| Hospital Charge Code |
2972200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$663.46 |
| Max. Negotiated Rate |
$1,245.68 |
| Rate for Payer: Aetna Commercial |
$1,218.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,164.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.62
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,245.68
|
| Rate for Payer: Health EOS Commercial |
$1,205.06
|
| Rate for Payer: HFN Commercial |
$1,245.68
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$812.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,245.68
|
| Rate for Payer: Quartz Beloit One Network |
$663.46
|
| Rate for Payer: Quartz Commercial |
$812.40
|
| Rate for Payer: WEA Trust Commercial |
$744.70
|
| Rate for Payer: WPS Commercial |
$1,002.91
|
|
|
Resp Viral Panel PCR
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$463.54 |
| Max. Negotiated Rate |
$870.32 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$567.60
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
Resp Viral Panel PCR
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.24 |
| Max. Negotiated Rate |
$1,471.23 |
| Rate for Payer: Aetna Commercial |
$898.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$898.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$473.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$567.60
|
| Rate for Payer: Health EOS Commercial |
$860.86
|
| Rate for Payer: HFN Commercial |
$898.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,471.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,471.23
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: Preferred Network Access Commercial |
$898.70
|
| Rate for Payer: Quartz Beloit One Network |
$416.24
|
| Rate for Payer: Quartz Commercial |
$539.22
|
| Rate for Payer: The Alliance Commercial |
$473.00
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
Resp Viral Panel PCR
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.78 |
| Max. Negotiated Rate |
$1,667.12 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Aetna Managed Medicare |
$416.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,562.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$729.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.85
|
| Rate for Payer: Anthem Medicaid |
$430.66
|
| Rate for Payer: Anthem Medicare Advantage |
$416.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$416.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$416.78
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$416.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$430.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.38
|
| Rate for Payer: Dean Health Medicaid |
$430.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$416.78
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,550.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$430.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$416.78
|
| Rate for Payer: Managed Health Services Medicaid |
$447.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$416.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$416.78
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$625.17
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$430.66
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$614.90
|
| Rate for Payer: Quartz Medicare Advantage |
$416.78
|
| Rate for Payer: The Alliance Commercial |
$1,667.12
|
| Rate for Payer: United Healthcare Medicaid |
$430.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare PPO |
$709.50
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: Wellcare Medicare |
$416.78
|
| Rate for Payer: WMAP Medicaid |
$430.66
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
Resp Virus PCR IV / 91233
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$2,841.88 |
| Rate for Payer: Aetna Commercial |
$2,780.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,656.54
|
| Rate for Payer: Aetna Managed Medicare |
$218.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$817.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.98
|
| Rate for Payer: Anthem Medicaid |
$225.32
|
| Rate for Payer: Anthem Medicare Advantage |
$218.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,637.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$218.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$218.06
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,841.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$218.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,728.60
|
| Rate for Payer: Dean Health Medicaid |
$225.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$218.06
|
| Rate for Payer: Health EOS Commercial |
$2,749.21
|
| Rate for Payer: HFN Commercial |
$2,841.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$218.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$225.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$218.06
|
| Rate for Payer: Managed Health Services Medicaid |
$234.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$218.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$218.06
|
| Rate for Payer: Multiplan Commercial |
$2,471.20
|
| Rate for Payer: NAPHCARE Commercial |
$327.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,841.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$225.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.61
|
| Rate for Payer: Quartz Commercial |
$2,007.85
|
| Rate for Payer: Quartz Medicare Advantage |
$218.06
|
| Rate for Payer: The Alliance Commercial |
$872.24
|
| Rate for Payer: United Healthcare Medicaid |
$225.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$218.06
|
| Rate for Payer: United Healthcare PPO |
$2,316.75
|
| Rate for Payer: WEA Trust Commercial |
$1,698.95
|
| Rate for Payer: Wellcare Medicare |
$218.06
|
| Rate for Payer: WMAP Medicaid |
$225.32
|
| Rate for Payer: WPS Commercial |
$2,288.02
|
|
|
Resp Virus PCR IV / 91233
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$769.75 |
| Max. Negotiated Rate |
$2,934.55 |
| Rate for Payer: Aetna Commercial |
$2,934.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,656.54
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,934.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,544.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,853.40
|
| Rate for Payer: Health EOS Commercial |
$2,810.99
|
| Rate for Payer: HFN Commercial |
$2,934.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$769.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$769.75
|
| Rate for Payer: Multiplan Commercial |
$2,471.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,934.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.16
|
| Rate for Payer: Quartz Commercial |
$1,760.73
|
| Rate for Payer: The Alliance Commercial |
$1,544.50
|
| Rate for Payer: WEA Trust Commercial |
$1,698.95
|
| Rate for Payer: WPS Commercial |
$2,288.02
|
|
|
Resp Virus PCR IV / 91233
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,513.61 |
| Max. Negotiated Rate |
$2,841.88 |
| Rate for Payer: Aetna Commercial |
$2,780.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,656.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,637.17
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,841.88
|
| Rate for Payer: Health EOS Commercial |
$2,749.21
|
| Rate for Payer: HFN Commercial |
$2,841.88
|
| Rate for Payer: Multiplan Commercial |
$2,471.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,853.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,841.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.61
|
| Rate for Payer: Quartz Commercial |
$1,853.40
|
| Rate for Payer: WEA Trust Commercial |
$1,698.95
|
| Rate for Payer: WPS Commercial |
$2,288.02
|
|
|
Resting Pan,Dorsal Block Splint Custom
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
2989890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.08 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Aetna Managed Medicare |
$101.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$168.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.02
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$234.65
|
| Rate for Payer: Quartz Medicare Advantage |
$216.60
|
| Rate for Payer: The Alliance Commercial |
$1,444.00
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Resting Pan,Dorsal Block Splint Custom
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
2989890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$332.12 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$216.60
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Resting Pan Splint Prefab
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
2989891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Resting Pan Splint Prefab
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
2989891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$142.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
RESTRAINT ELBOW LRG FREEDOM
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
2963860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
RESTRAINT ELBOW LRG FREEDOM
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
2963860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
RESTRAINT ELBOW SMALL FREEDOM
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
2963859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
RESTRAINT ELBOW SMALL FREEDOM
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
2963859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
RESTRAINT HAND MITT
|
Facility
|
IP
|
$539.00
|
|
| Hospital Charge Code |
2969245
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$495.88 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$323.40
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
RESTRAINT HAND MITT
|
Facility
|
OP
|
$539.00
|
|
| Hospital Charge Code |
2969245
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$2,156.00 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Aetna Managed Medicare |
$150.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.62
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$350.35
|
| Rate for Payer: Quartz Medicare Advantage |
$323.40
|
| Rate for Payer: The Alliance Commercial |
$2,156.00
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
RESTRAINT SKINSLEEVE ARM DARK MED
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
2969246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
RESTRAINT SKINSLEEVE ARM DARK MED
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
2969246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT MED 6000
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2969228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT MED 6000
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2969228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT SM 6000S
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2969229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT SM 6000S
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2969229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
