|
Ref HLA-AB Low Resolution
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
980075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Ref HLA Antibody Class II
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody Class II
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody Detect and ID
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
980076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Ref HLA Antibody Detect and ID
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
980076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Ref HLA Antibody ID Class I
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody ID Class I
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
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
|
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
|
Facility
|
OP
|
$33.47
|
|
|
Service Code
|
EAPG 00870
|
| Min. Negotiated Rate |
$32.18 |
| Max. Negotiated Rate |
$33.47 |
| Rate for Payer: Anthem Medicaid |
$32.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.18
|
| Rate for Payer: Dean Health Medicaid |
$32.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32.18
|
| Rate for Payer: Managed Health Services Medicaid |
$33.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32.18
|
| Rate for Payer: United Healthcare Medicaid |
$32.18
|
|
|
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
|
$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
|
$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 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
|
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
|
|
