|
Resp Viral Panel PCR
|
Facility
|
OP
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$433.45 |
| Max. Negotiated Rate |
$1,733.80 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$433.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,625.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.53
|
| Rate for Payer: Anthem Medicare Advantage |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$433.45
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$433.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$433.45
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,612.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$433.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$433.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$433.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$433.45
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$650.18
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$639.50
|
| Rate for Payer: Quartz Medicare Advantage |
$433.45
|
| Rate for Payer: The Alliance Commercial |
$1,733.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$433.45
|
| Rate for Payer: United Healthcare PPO |
$737.88
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: Wellcare Medicare |
$433.45
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
Resp Viral Panel PCR
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$432.89 |
| Max. Negotiated Rate |
$1,907.19 |
| Rate for Payer: Aetna Commercial |
$934.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$433.45
|
| Rate for Payer: Anthem Medicare Advantage |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$433.45
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$934.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$491.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.45
|
| Rate for Payer: Health EOS Commercial |
$895.29
|
| Rate for Payer: HFN Commercial |
$934.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,530.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,530.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$433.45
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$650.18
|
| Rate for Payer: Preferred Network Access Commercial |
$934.65
|
| Rate for Payer: Quartz Beloit One Network |
$432.89
|
| Rate for Payer: Quartz Commercial |
$560.79
|
| Rate for Payer: Quartz Medicare Advantage |
$433.45
|
| Rate for Payer: The Alliance Commercial |
$1,712.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$433.45
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$1,907.19
|
|
|
Resp Viral Panel PCR
|
Facility
|
IP
|
$946.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
6187413
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$482.08 |
| Max. Negotiated Rate |
$905.13 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$590.30
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
Resp Virus PCR IV / 91233
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.78 |
| Max. Negotiated Rate |
$2,955.56 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Aetna Managed Medicare |
$226.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.46
|
| Rate for Payer: Anthem Medicare Advantage |
$226.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,702.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.78
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$226.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,797.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$226.78
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$226.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$226.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$226.78
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: NAPHCARE Commercial |
$340.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$2,088.16
|
| Rate for Payer: Quartz Medicare Advantage |
$226.78
|
| Rate for Payer: The Alliance Commercial |
$907.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.78
|
| Rate for Payer: United Healthcare PPO |
$2,409.42
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: Wellcare Medicare |
$226.78
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
Resp Virus PCR IV / 91233
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.78 |
| Max. Negotiated Rate |
$3,051.93 |
| Rate for Payer: Aetna Commercial |
$3,051.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Aetna Managed Medicare |
$226.78
|
| Rate for Payer: Anthem Medicare Advantage |
$226.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.78
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$3,051.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,606.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.78
|
| Rate for Payer: Health EOS Commercial |
$2,923.43
|
| Rate for Payer: HFN Commercial |
$3,051.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$800.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$800.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.78
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: NAPHCARE Commercial |
$340.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,051.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.53
|
| Rate for Payer: Quartz Commercial |
$1,831.16
|
| Rate for Payer: Quartz Medicare Advantage |
$226.78
|
| Rate for Payer: The Alliance Commercial |
$895.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.78
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$997.84
|
|
|
Resp Virus PCR IV / 91233
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 87632
|
| Hospital Charge Code |
4614610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,574.15 |
| Max. Negotiated Rate |
$2,955.56 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,702.66
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$1,927.54
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
Resting Pan,Dorsal Block Splint Custom
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
2989890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$1,657.47 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Aetna Managed Medicare |
$105.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$175.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.10
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: NAPHCARE Commercial |
$225.26
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$244.04
|
| Rate for Payer: Quartz Medicare Advantage |
$225.26
|
| Rate for Payer: The Alliance Commercial |
$1,657.47
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Resting Pan,Dorsal Block Splint Custom
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
2989890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.97 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$225.26
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Resting Pan Splint Prefab
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
2989891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Resting Pan Splint Prefab
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
2989891
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,163.43 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$1,163.43
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
RESTRAINT ELBOW LRG FREEDOM
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
2963860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
RESTRAINT ELBOW LRG FREEDOM
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
2963860
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.49
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.26
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$197.81
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$197.81
|
| Rate for Payer: The Alliance Commercial |
$164.84
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
RESTRAINT ELBOW SMALL FREEDOM
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
2963859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.49
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.26
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$197.81
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$197.81
|
| Rate for Payer: The Alliance Commercial |
$164.84
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
RESTRAINT ELBOW SMALL FREEDOM
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
2963859
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
RESTRAINT HAND MITT
|
Facility
|
IP
|
$539.00
|
|
| Hospital Charge Code |
2969245
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$274.67 |
| Max. Negotiated Rate |
$515.72 |
| Rate for Payer: Aetna Commercial |
$504.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.10
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$515.72
|
| Rate for Payer: Health EOS Commercial |
$498.90
|
| Rate for Payer: HFN Commercial |
$515.72
|
| Rate for Payer: Multiplan Commercial |
$448.45
|
| Rate for Payer: Preferred Network Access Commercial |
$515.72
|
| Rate for Payer: Quartz Beloit One Network |
$274.67
|
| Rate for Payer: Quartz Commercial |
$336.34
|
| Rate for Payer: WEA Trust Commercial |
$308.31
|
| Rate for Payer: WPS Commercial |
$415.19
|
|
|
RESTRAINT HAND MITT
|
Facility
|
OP
|
$539.00
|
|
| Hospital Charge Code |
2969245
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$515.72 |
| Rate for Payer: Aetna Commercial |
$504.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.08
|
| Rate for Payer: Aetna Managed Medicare |
$156.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.10
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$515.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.70
|
| Rate for Payer: Health EOS Commercial |
$498.90
|
| Rate for Payer: HFN Commercial |
$515.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.42
|
| Rate for Payer: Multiplan Commercial |
$448.45
|
| Rate for Payer: NAPHCARE Commercial |
$336.34
|
| Rate for Payer: Preferred Network Access Commercial |
$515.72
|
| Rate for Payer: Quartz Beloit One Network |
$274.67
|
| Rate for Payer: Quartz Commercial |
$364.36
|
| Rate for Payer: Quartz Medicare Advantage |
$336.34
|
| Rate for Payer: The Alliance Commercial |
$280.28
|
| Rate for Payer: WEA Trust Commercial |
$308.31
|
| Rate for Payer: WPS Commercial |
$415.19
|
|
|
RESTRAINT SKINSLEEVE ARM DARK MED
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
2969246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
RESTRAINT SKINSLEEVE ARM DARK MED
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
2969246
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.94
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$115.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT MED 6000
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2969228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT MED 6000
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2969228
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT SM 6000S
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2969229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
RESTRAINT SKINSLEEVE ARM LIGHT SM 6000S
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2969229
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
RESTRAINTS WRIST QUICK RELEASE 2531
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
2963037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$13.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.19
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.10
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$28.08
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$28.08
|
| Rate for Payer: The Alliance Commercial |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
RESTRAINTS WRIST QUICK RELEASE 2531
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
2963037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Result
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
