|
Ref Platelet Antibody Screen
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Ref Platelet Antibody Screen
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Ref Platelet Autoantibodies
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Ref Platelet Autoantibodies
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
REG TULIS CL.HEEL CUP 7873-01
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
REG TULIS CL.HEEL CUP 7873-01
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
REHABILITATION
|
Facility
|
OP
|
$81.24
|
|
|
Service Code
|
EAPG 00870
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$81.24 |
| Rate for Payer: Anthem Medicaid |
$78.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$78.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.11
|
| Rate for Payer: Dean Health Medicaid |
$78.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$78.11
|
| Rate for Payer: Managed Health Services Medicaid |
$81.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$78.11
|
| Rate for Payer: United Healthcare Medicaid |
$78.11
|
|
|
REHABILITATION
|
Facility
|
IP
|
$17,010.52
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$15,109.81 |
| Max. Negotiated Rate |
$17,010.52 |
| Rate for Payer: Anthem Medicaid |
$16,288.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,288.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,288.51
|
| Rate for Payer: Dean Health Medicaid |
$16,288.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,109.81
|
| Rate for Payer: Managed Health Services Medicaid |
$17,010.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,288.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,288.51
|
| Rate for Payer: United Healthcare Medicaid |
$16,288.51
|
|
|
REHABILITATION
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
REHABILITATION
|
Facility
|
IP
|
$21,131.63
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$18,770.43 |
| Max. Negotiated Rate |
$21,131.63 |
| Rate for Payer: Anthem Medicaid |
$20,234.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,234.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,234.70
|
| Rate for Payer: Dean Health Medicaid |
$20,234.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,770.43
|
| Rate for Payer: Managed Health Services Medicaid |
$21,131.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,234.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,234.70
|
| Rate for Payer: United Healthcare Medicaid |
$20,234.70
|
|
|
REHABILITATION
|
Facility
|
IP
|
$12,889.42
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$11,449.18 |
| Max. Negotiated Rate |
$12,889.42 |
| Rate for Payer: Anthem Medicaid |
$12,342.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,342.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,342.33
|
| Rate for Payer: Dean Health Medicaid |
$12,342.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,449.18
|
| Rate for Payer: Managed Health Services Medicaid |
$12,889.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,342.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,342.33
|
| Rate for Payer: United Healthcare Medicaid |
$12,342.33
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$42,070.08
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$42,070.08 |
| Rate for Payer: Aetna Managed Medicare |
$12,366.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,789.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,899.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,605.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12,366.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,366.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,366.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,366.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,314.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,366.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,600.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,366.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,366.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,366.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,366.28
|
| Rate for Payer: NAPHCARE Commercial |
$18,549.41
|
| Rate for Payer: Quartz Medicare Advantage |
$12,366.28
|
| Rate for Payer: The Alliance Commercial |
$42,070.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,366.28
|
| Rate for Payer: United Healthcare PPO |
$23,832.35
|
| Rate for Payer: Wellcare Medicare |
$12,366.28
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$28,333.76
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$2,600.00 |
| Max. Negotiated Rate |
$28,333.76 |
| Rate for Payer: Aetna Managed Medicare |
$9,289.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,022.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,179.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,221.64
|
| Rate for Payer: Anthem Medicare Advantage |
$9,289.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,289.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,289.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,289.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,227.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,289.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,600.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,289.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,289.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,289.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,289.21
|
| Rate for Payer: NAPHCARE Commercial |
$13,933.81
|
| Rate for Payer: Quartz Medicare Advantage |
$9,289.21
|
| Rate for Payer: The Alliance Commercial |
$28,333.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,289.21
|
| Rate for Payer: United Healthcare PPO |
$15,988.75
|
| Rate for Payer: Wellcare Medicare |
$9,289.21
|
|
|
Reinforced ET Tube
|
Facility
|
IP
|
$1,094.00
|
|
| Hospital Charge Code |
3101742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$557.50 |
| Max. Negotiated Rate |
$1,046.74 |
| Rate for Payer: Aetna Commercial |
$1,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.01
|
| Rate for Payer: Cash Price |
$328.20
|
| Rate for Payer: Cigna Commercial |
$1,046.74
|
| Rate for Payer: Health EOS Commercial |
$1,012.61
|
| Rate for Payer: HFN Commercial |
$1,046.74
|
| Rate for Payer: Multiplan Commercial |
$910.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.74
|
| Rate for Payer: Quartz Beloit One Network |
$557.50
|
| Rate for Payer: Quartz Commercial |
$682.66
|
| Rate for Payer: WEA Trust Commercial |
$625.77
|
| Rate for Payer: WPS Commercial |
$842.71
|
|
|
Reinforced ET Tube
|
Facility
|
OP
|
$1,094.00
|
|
| Hospital Charge Code |
3101742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.57 |
| Max. Negotiated Rate |
$1,046.74 |
| Rate for Payer: Aetna Commercial |
$1,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.47
|
| Rate for Payer: Aetna Managed Medicare |
$318.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$739.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$546.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.01
|
| Rate for Payer: Cash Price |
$328.20
|
| Rate for Payer: Cigna Commercial |
$1,046.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.71
|
| Rate for Payer: Health EOS Commercial |
$1,012.61
|
| Rate for Payer: HFN Commercial |
$1,046.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$853.32
|
| Rate for Payer: Multiplan Commercial |
$910.21
|
| Rate for Payer: NAPHCARE Commercial |
$682.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.74
|
| Rate for Payer: Quartz Beloit One Network |
$557.50
|
| Rate for Payer: Quartz Commercial |
$739.54
|
| Rate for Payer: Quartz Medicare Advantage |
$682.66
|
| Rate for Payer: The Alliance Commercial |
$568.88
|
| Rate for Payer: WEA Trust Commercial |
$625.77
|
| Rate for Payer: WPS Commercial |
$842.71
|
|
|
REINFORCEMENT ECHELON 60MM ECH60R
|
Facility
|
IP
|
$2,901.00
|
|
| Hospital Charge Code |
5885640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.35 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,810.22
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
REINFORCEMENT ECHELON 60MM ECH60R
|
Facility
|
OP
|
$2,901.00
|
|
| Hospital Charge Code |
5885640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.77 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$844.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.38
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.78
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,961.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.22
|
| Rate for Payer: The Alliance Commercial |
$1,508.52
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON ENDO SURGERY EC60 12BSGEC60
|
Facility
|
IP
|
$2,199.00
|
|
| Hospital Charge Code |
5547400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.61 |
| Max. Negotiated Rate |
$2,104.00 |
| Rate for Payer: Aetna Commercial |
$2,058.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.09
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna Commercial |
$2,104.00
|
| Rate for Payer: Health EOS Commercial |
$2,035.39
|
| Rate for Payer: HFN Commercial |
$2,104.00
|
| Rate for Payer: Multiplan Commercial |
$1,829.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.61
|
| Rate for Payer: Quartz Commercial |
$1,372.18
|
| Rate for Payer: WEA Trust Commercial |
$1,257.83
|
| Rate for Payer: WPS Commercial |
$1,693.89
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON ENDO SURGERY EC60 12BSGEC60
|
Facility
|
OP
|
$2,199.00
|
|
| Hospital Charge Code |
5547400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.35 |
| Max. Negotiated Rate |
$2,104.00 |
| Rate for Payer: Aetna Commercial |
$2,058.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,966.79
|
| Rate for Payer: Aetna Managed Medicare |
$640.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,486.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,143.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,097.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.09
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna Commercial |
$2,104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.82
|
| Rate for Payer: Health EOS Commercial |
$2,035.39
|
| Rate for Payer: HFN Commercial |
$2,104.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,715.22
|
| Rate for Payer: Multiplan Commercial |
$1,829.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.61
|
| Rate for Payer: Quartz Commercial |
$1,486.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.18
|
| Rate for Payer: The Alliance Commercial |
$1,143.48
|
| Rate for Payer: WEA Trust Commercial |
$1,257.83
|
| Rate for Payer: WPS Commercial |
$1,693.89
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON PROXIMATE 75 12OBSGPROX75
|
Facility
|
IP
|
$12,314.00
|
|
| Hospital Charge Code |
4640790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,275.21 |
| Max. Negotiated Rate |
$11,782.04 |
| Rate for Payer: Aetna Commercial |
$11,525.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,013.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,787.48
|
| Rate for Payer: Cash Price |
$3,694.20
|
| Rate for Payer: Cigna Commercial |
$11,782.04
|
| Rate for Payer: Health EOS Commercial |
$11,397.84
|
| Rate for Payer: HFN Commercial |
$11,782.04
|
| Rate for Payer: Multiplan Commercial |
$10,245.25
|
| Rate for Payer: Preferred Network Access Commercial |
$11,782.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,275.21
|
| Rate for Payer: Quartz Commercial |
$7,683.94
|
| Rate for Payer: WEA Trust Commercial |
$7,043.61
|
| Rate for Payer: WPS Commercial |
$9,485.47
|
|
|
REINFORCEMENT GORE SEAMGUARD ETHICON PROXIMATE 75 12OBSGPROX75
|
Facility
|
OP
|
$12,314.00
|
|
| Hospital Charge Code |
4640790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,585.84 |
| Max. Negotiated Rate |
$11,782.04 |
| Rate for Payer: Aetna Commercial |
$11,525.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,013.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,585.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,324.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,403.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,147.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,787.48
|
| Rate for Payer: Cash Price |
$3,694.20
|
| Rate for Payer: Cigna Commercial |
$11,782.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,166.75
|
| Rate for Payer: Health EOS Commercial |
$11,397.84
|
| Rate for Payer: HFN Commercial |
$11,782.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,604.92
|
| Rate for Payer: Multiplan Commercial |
$10,245.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,683.94
|
| Rate for Payer: Preferred Network Access Commercial |
$11,782.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,275.21
|
| Rate for Payer: Quartz Commercial |
$8,324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$7,683.94
|
| Rate for Payer: The Alliance Commercial |
$6,403.28
|
| Rate for Payer: WEA Trust Commercial |
$7,043.61
|
| Rate for Payer: WPS Commercial |
$9,485.47
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
RELEASE OF BIG TOE 28240
|
Professional
|
Both
|
$1,310.00
|
|
|
Service Code
|
CPT 28240
|
| Hospital Charge Code |
3014224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,294.28 |
| Rate for Payer: Aetna Commercial |
$1,294.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,171.66
|
| Rate for Payer: Aetna Managed Medicare |
$272.31
|
| Rate for Payer: Anthem Medicare Advantage |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.31
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$1,294.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.31
|
| Rate for Payer: Health EOS Commercial |
$1,239.78
|
| Rate for Payer: HFN Commercial |
$1,294.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,032.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.31
|
| Rate for Payer: Multiplan Commercial |
$1,089.92
|
| Rate for Payer: NAPHCARE Commercial |
$408.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.28
|
| Rate for Payer: Quartz Beloit One Network |
$599.46
|
| Rate for Payer: Quartz Commercial |
$776.57
|
| Rate for Payer: Quartz Medicare Advantage |
$272.31
|
| Rate for Payer: The Alliance Commercial |
$1,157.33
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.31
|
| Rate for Payer: WEA Trust Commercial |
$749.32
|
| Rate for Payer: WPS Commercial |
$1,225.41
|
|
|
RELEASE OF FOOT CONTRACTURE 28270
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
CPT 28270
|
| Hospital Charge Code |
3014226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$312.53 |
| Max. Negotiated Rate |
$1,406.39 |
| Rate for Payer: Aetna Commercial |
$1,131.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.09
|
| Rate for Payer: Aetna Managed Medicare |
$312.53
|
| Rate for Payer: Anthem Medicare Advantage |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$312.53
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cash Price |
$343.50
|
| Rate for Payer: Cigna Commercial |
$1,131.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$559.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.53
|
| Rate for Payer: Health EOS Commercial |
$1,083.63
|
| Rate for Payer: HFN Commercial |
$1,131.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,173.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$312.53
|
| Rate for Payer: Multiplan Commercial |
$952.64
|
| Rate for Payer: NAPHCARE Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.26
|
| Rate for Payer: Quartz Beloit One Network |
$523.95
|
| Rate for Payer: Quartz Commercial |
$678.76
|
| Rate for Payer: Quartz Medicare Advantage |
$312.53
|
| Rate for Payer: The Alliance Commercial |
$1,328.25
|
| Rate for Payer: United Healthcare Medicaid |
$559.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.53
|
| Rate for Payer: WEA Trust Commercial |
$654.94
|
| Rate for Payer: WPS Commercial |
$1,406.39
|
|
|
RELEASE OF FOOT TENDON 28220
|
Professional
|
Both
|
$1,858.00
|
|
|
Service Code
|
CPT 28220
|
| Hospital Charge Code |
3014218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.22 |
| Max. Negotiated Rate |
$1,835.70 |
| Rate for Payer: Aetna Commercial |
$1,835.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,661.80
|
| Rate for Payer: Aetna Managed Medicare |
$284.22
|
| Rate for Payer: Anthem Medicare Advantage |
$284.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$284.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$284.22
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cash Price |
$557.40
|
| Rate for Payer: Cigna Commercial |
$1,835.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.22
|
| Rate for Payer: Health EOS Commercial |
$1,758.41
|
| Rate for Payer: HFN Commercial |
$1,835.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,065.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,065.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$284.22
|
| Rate for Payer: Multiplan Commercial |
$1,545.86
|
| Rate for Payer: NAPHCARE Commercial |
$426.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.70
|
| Rate for Payer: Quartz Beloit One Network |
$850.22
|
| Rate for Payer: Quartz Commercial |
$1,101.42
|
| Rate for Payer: Quartz Medicare Advantage |
$284.22
|
| Rate for Payer: The Alliance Commercial |
$1,207.94
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$284.22
|
| Rate for Payer: WEA Trust Commercial |
$1,062.78
|
| Rate for Payer: WPS Commercial |
$1,279.00
|
|
