|
RESTRAINTS WRIST QUICK RELEASE 2531
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
2963037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
RESTRAINTS WRIST QUICK RELEASE 2531
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
2963037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.18
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$27.00
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Result
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.19
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Result
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.54
|
| Rate for Payer: Anthem Medicaid |
$20.25
|
| Rate for Payer: Anthem Medicare Advantage |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.60
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Dean Health Medicaid |
$20.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.60
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.60
|
| Rate for Payer: Managed Health Services Medicaid |
$21.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.25
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$19.60
|
| Rate for Payer: The Alliance Commercial |
$78.40
|
| Rate for Payer: United Healthcare Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.60
|
| Rate for Payer: United Healthcare PPO |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: Wellcare Medicare |
$19.60
|
| Rate for Payer: WMAP Medicaid |
$20.25
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Result
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Results Reviewed By
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Results Reviewed By
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$31.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Results Reviewed By
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
RESURFACING TOOL 2.5MM EGG 1900-015-025
|
Facility
|
IP
|
$1,550.00
|
|
| Hospital Charge Code |
5729721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.50 |
| Max. Negotiated Rate |
$1,426.00 |
| Rate for Payer: Aetna Commercial |
$1,395.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,333.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$821.50
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$1,426.00
|
| Rate for Payer: Health EOS Commercial |
$1,379.50
|
| Rate for Payer: HFN Commercial |
$1,426.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$930.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.00
|
| Rate for Payer: Quartz Beloit One Network |
$759.50
|
| Rate for Payer: Quartz Commercial |
$930.00
|
| Rate for Payer: WEA Trust Commercial |
$852.50
|
| Rate for Payer: WPS Commercial |
$1,148.08
|
|
|
RESURFACING TOOL 2.5MM EGG 1900-015-025
|
Facility
|
OP
|
$1,550.00
|
|
| Hospital Charge Code |
5729721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$6,200.00 |
| Rate for Payer: Aetna Commercial |
$1,395.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,333.00
|
| Rate for Payer: Aetna Managed Medicare |
$434.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,007.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$775.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$821.50
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$1,426.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$867.38
|
| Rate for Payer: Health EOS Commercial |
$1,379.50
|
| Rate for Payer: HFN Commercial |
$1,426.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,162.50
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: NAPHCARE Commercial |
$930.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.00
|
| Rate for Payer: Quartz Beloit One Network |
$759.50
|
| Rate for Payer: Quartz Commercial |
$1,007.50
|
| Rate for Payer: Quartz Medicare Advantage |
$930.00
|
| Rate for Payer: The Alliance Commercial |
$6,200.00
|
| Rate for Payer: WEA Trust Commercial |
$852.50
|
| Rate for Payer: WPS Commercial |
$1,148.08
|
|
|
RESURFACING TOOL 4.0MM EGG 1900-015-040
|
Facility
|
IP
|
$1,508.00
|
|
| Hospital Charge Code |
5729718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.92 |
| Max. Negotiated Rate |
$1,387.36 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.98
|
|
|
RESURFACING TOOL 4.0MM EGG 1900-015-040
|
Facility
|
OP
|
$1,508.00
|
|
| Hospital Charge Code |
5729718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.24 |
| Max. Negotiated Rate |
$6,032.00 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Aetna Managed Medicare |
$422.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$980.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$754.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$723.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$843.88
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,131.00
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$980.20
|
| Rate for Payer: Quartz Medicare Advantage |
$904.80
|
| Rate for Payer: The Alliance Commercial |
$6,032.00
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.98
|
|
|
Reticulocyte Count
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.60
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: HFN Commercial |
$91.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Reticulocyte Count
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Reticulocyte Count
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$3.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.62
|
| Rate for Payer: Anthem Medicaid |
$4.12
|
| Rate for Payer: Anthem Medicare Advantage |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.99
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Dean Health Medicaid |
$4.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.99
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.99
|
| Rate for Payer: Managed Health Services Medicaid |
$4.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.98
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.12
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$15.96
|
| Rate for Payer: United Healthcare Medicaid |
$4.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.99
|
| Rate for Payer: United Healthcare PPO |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: Wellcare Medicare |
$3.99
|
| Rate for Payer: WMAP Medicaid |
$4.12
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$26,752.00
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$9,623.09 |
| Max. Negotiated Rate |
$26,752.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,623.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,623.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,623.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,623.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,623.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,623.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,386.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,623.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,623.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,623.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,623.09
|
| Rate for Payer: NAPHCARE Commercial |
$14,434.64
|
| Rate for Payer: Quartz Medicare Advantage |
$9,623.09
|
| Rate for Payer: The Alliance Commercial |
$26,752.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,623.09
|
| Rate for Payer: United Healthcare PPO |
$15,092.95
|
| Rate for Payer: Wellcare Medicare |
$9,623.09
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$56,898.00
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$20,466.90 |
| Max. Negotiated Rate |
$56,898.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,466.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,687.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,252.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,542.14
|
| Rate for Payer: Anthem Medicare Advantage |
$20,466.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,466.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,466.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,466.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,124.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,466.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,497.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,466.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,466.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,466.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,466.90
|
| Rate for Payer: NAPHCARE Commercial |
$30,700.35
|
| Rate for Payer: Quartz Medicare Advantage |
$20,466.90
|
| Rate for Payer: The Alliance Commercial |
$56,898.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,466.90
|
| Rate for Payer: United Healthcare PPO |
$32,306.69
|
| Rate for Payer: Wellcare Medicare |
$20,466.90
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,202.00
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$6,907.12 |
| Max. Negotiated Rate |
$19,202.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,907.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,895.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,417.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,847.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6,907.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,907.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,907.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,907.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,041.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,907.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,848.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,907.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,907.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,907.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,907.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,360.68
|
| Rate for Payer: Quartz Medicare Advantage |
$6,907.12
|
| Rate for Payer: The Alliance Commercial |
$19,202.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,907.12
|
| Rate for Payer: United Healthcare PPO |
$10,781.55
|
| Rate for Payer: Wellcare Medicare |
$6,907.12
|
|
|
RETINAL DETACHMENT/REATTACHMENT, INTRAOCULAR GAS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
RETINAL DETACHMENT/REATTACHMENT, INTRAOCULAR GAS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
RETRACTION CLIP CORONARY ARTERY 3.0MM STERILE 16130
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
2965339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
RETRACTION CLIP CORONARY ARTERY 3.0MM STERILE 16130
|
Facility
|
OP
|
$328.00
|
|
| Hospital Charge Code |
2965339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
RETRACTOR ALEXIS WOUND LARGE C8303
|
Facility
|
OP
|
$1,189.00
|
|
| Hospital Charge Code |
4520202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.92 |
| Max. Negotiated Rate |
$4,756.00 |
| Rate for Payer: Aetna Commercial |
$1,070.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,022.54
|
| Rate for Payer: Aetna Managed Medicare |
$332.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$570.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.17
|
| Rate for Payer: Cash Price |
$356.70
|
| Rate for Payer: Cigna Commercial |
$1,093.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.36
|
| Rate for Payer: Health EOS Commercial |
$1,058.21
|
| Rate for Payer: HFN Commercial |
$1,093.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$891.75
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: NAPHCARE Commercial |
$713.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.88
|
| Rate for Payer: Quartz Beloit One Network |
$582.61
|
| Rate for Payer: Quartz Commercial |
$772.85
|
| Rate for Payer: Quartz Medicare Advantage |
$713.40
|
| Rate for Payer: The Alliance Commercial |
$4,756.00
|
| Rate for Payer: WEA Trust Commercial |
$653.95
|
| Rate for Payer: WPS Commercial |
$880.69
|
|
|
RETRACTOR ALEXIS WOUND LARGE C8303
|
Facility
|
IP
|
$1,189.00
|
|
| Hospital Charge Code |
4520202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$1,093.88 |
| Rate for Payer: Aetna Commercial |
$1,070.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,022.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.17
|
| Rate for Payer: Cash Price |
$356.70
|
| Rate for Payer: Cigna Commercial |
$1,093.88
|
| Rate for Payer: Health EOS Commercial |
$1,058.21
|
| Rate for Payer: HFN Commercial |
$1,093.88
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: NAPHCARE Commercial |
$713.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.88
|
| Rate for Payer: Quartz Beloit One Network |
$582.61
|
| Rate for Payer: Quartz Commercial |
$713.40
|
| Rate for Payer: WEA Trust Commercial |
$653.95
|
| Rate for Payer: WPS Commercial |
$880.69
|
|
|
RETRACTOR ALEXIS WOUND MEDIUM C8302
|
Facility
|
OP
|
$1,707.00
|
|
| Hospital Charge Code |
2964644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.96 |
| Max. Negotiated Rate |
$6,828.00 |
| Rate for Payer: Aetna Commercial |
$1,536.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.02
|
| Rate for Payer: Aetna Managed Medicare |
$477.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$904.71
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna Commercial |
$1,570.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.24
|
| Rate for Payer: Health EOS Commercial |
$1,519.23
|
| Rate for Payer: HFN Commercial |
$1,570.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,280.25
|
| Rate for Payer: Multiplan Commercial |
$1,365.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,570.44
|
| Rate for Payer: Quartz Beloit One Network |
$836.43
|
| Rate for Payer: Quartz Commercial |
$1,109.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.20
|
| Rate for Payer: The Alliance Commercial |
$6,828.00
|
| Rate for Payer: WEA Trust Commercial |
$938.85
|
| Rate for Payer: WPS Commercial |
$1,264.37
|
|
