|
Result
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$215.38 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Medicare Advantage |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.38
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.38
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.38
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$30.58
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$20.38
|
| Rate for Payer: The Alliance Commercial |
$80.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.38
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$89.69
|
|
|
Result
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
2942879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.84
|
| Rate for Payer: Anthem Medicare Advantage |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.38
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.38
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.38
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$30.58
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$20.38
|
| Rate for Payer: The Alliance Commercial |
$81.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.38
|
| Rate for Payer: United Healthcare PPO |
$170.04
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$20.38
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Results Reviewed By
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.14
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Results Reviewed By
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Results Reviewed By
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2778816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.92
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$71.14
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
RESURFACING TOOL 2.5MM EGG 1900-015-025
|
Facility
|
OP
|
$1,550.00
|
|
| Hospital Charge Code |
5729721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.36 |
| Max. Negotiated Rate |
$1,483.04 |
| Rate for Payer: Aetna Commercial |
$1,450.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,386.32
|
| Rate for Payer: Aetna Managed Medicare |
$451.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,047.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$773.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.36
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$1,483.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.10
|
| Rate for Payer: Health EOS Commercial |
$1,434.68
|
| Rate for Payer: HFN Commercial |
$1,483.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.00
|
| Rate for Payer: Multiplan Commercial |
$1,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$967.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.04
|
| Rate for Payer: Quartz Beloit One Network |
$789.88
|
| Rate for Payer: Quartz Commercial |
$1,047.80
|
| Rate for Payer: Quartz Medicare Advantage |
$967.20
|
| Rate for Payer: The Alliance Commercial |
$806.00
|
| Rate for Payer: WEA Trust Commercial |
$886.60
|
| Rate for Payer: WPS Commercial |
$1,193.96
|
|
|
RESURFACING TOOL 2.5MM EGG 1900-015-025
|
Facility
|
IP
|
$1,550.00
|
|
| Hospital Charge Code |
5729721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.88 |
| Max. Negotiated Rate |
$1,483.04 |
| Rate for Payer: Aetna Commercial |
$1,450.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,386.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.36
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$1,483.04
|
| Rate for Payer: Health EOS Commercial |
$1,434.68
|
| Rate for Payer: HFN Commercial |
$1,483.04
|
| Rate for Payer: Multiplan Commercial |
$1,289.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.04
|
| Rate for Payer: Quartz Beloit One Network |
$789.88
|
| Rate for Payer: Quartz Commercial |
$967.20
|
| Rate for Payer: WEA Trust Commercial |
$886.60
|
| Rate for Payer: WPS Commercial |
$1,193.96
|
|
|
RESURFACING TOOL 4.0MM EGG 1900-015-040
|
Facility
|
IP
|
$1,508.00
|
|
| Hospital Charge Code |
5729718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.48 |
| Max. Negotiated Rate |
$1,442.85 |
| Rate for Payer: Aetna Commercial |
$1,411.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.21
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,442.85
|
| Rate for Payer: Health EOS Commercial |
$1,395.80
|
| Rate for Payer: HFN Commercial |
$1,442.85
|
| Rate for Payer: Multiplan Commercial |
$1,254.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.85
|
| Rate for Payer: Quartz Beloit One Network |
$768.48
|
| Rate for Payer: Quartz Commercial |
$940.99
|
| Rate for Payer: WEA Trust Commercial |
$862.58
|
| Rate for Payer: WPS Commercial |
$1,161.61
|
|
|
RESURFACING TOOL 4.0MM EGG 1900-015-040
|
Facility
|
OP
|
$1,508.00
|
|
| Hospital Charge Code |
5729718
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.13 |
| Max. Negotiated Rate |
$1,442.85 |
| Rate for Payer: Aetna Commercial |
$1,411.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.76
|
| Rate for Payer: Aetna Managed Medicare |
$439.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,019.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$784.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$752.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.21
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,442.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$877.66
|
| Rate for Payer: Health EOS Commercial |
$1,395.80
|
| Rate for Payer: HFN Commercial |
$1,442.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,176.24
|
| Rate for Payer: Multiplan Commercial |
$1,254.66
|
| Rate for Payer: NAPHCARE Commercial |
$940.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.85
|
| Rate for Payer: Quartz Beloit One Network |
$768.48
|
| Rate for Payer: Quartz Commercial |
$1,019.41
|
| Rate for Payer: Quartz Medicare Advantage |
$940.99
|
| Rate for Payer: The Alliance Commercial |
$784.16
|
| Rate for Payer: WEA Trust Commercial |
$862.58
|
| Rate for Payer: WPS Commercial |
$1,161.61
|
|
|
RESUSCITATION
|
Facility
|
OP
|
$410.12
|
|
|
Service Code
|
EAPG 00092
|
| Min. Negotiated Rate |
$394.35 |
| Max. Negotiated Rate |
$410.12 |
| Rate for Payer: Anthem Medicaid |
$394.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$394.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$394.35
|
| Rate for Payer: Dean Health Medicaid |
$394.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$394.35
|
| Rate for Payer: Managed Health Services Medicaid |
$410.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$394.35
|
| Rate for Payer: United Healthcare Medicaid |
$394.35
|
|
|
Reticulocyte Count
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$4.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.89
|
| Rate for Payer: Anthem Medicare Advantage |
$4.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.15
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.15
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$6.22
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4.15
|
| Rate for Payer: The Alliance Commercial |
$16.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.15
|
| Rate for Payer: United Healthcare PPO |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: Wellcare Medicare |
$4.15
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Reticulocyte Count
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$94.85 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$4.15
|
| Rate for Payer: Anthem Medicare Advantage |
$4.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.15
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.15
|
| Rate for Payer: Health EOS Commercial |
$90.85
|
| Rate for Payer: HFN Commercial |
$94.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$6.22
|
| Rate for Payer: Preferred Network Access Commercial |
$94.85
|
| Rate for Payer: Quartz Beloit One Network |
$43.93
|
| Rate for Payer: Quartz Commercial |
$56.91
|
| Rate for Payer: Quartz Medicare Advantage |
$4.15
|
| Rate for Payer: The Alliance Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.15
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$18.26
|
|
|
Reticulocyte Count
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
633822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$27,822.08
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$8,272.19 |
| Max. Negotiated Rate |
$27,822.08 |
| Rate for Payer: Aetna Managed Medicare |
$8,272.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,124.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,958.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,111.57
|
| Rate for Payer: Anthem Medicare Advantage |
$8,272.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,272.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,272.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,272.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,885.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,272.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,162.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,272.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,272.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,272.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,272.19
|
| Rate for Payer: NAPHCARE Commercial |
$12,408.29
|
| Rate for Payer: Quartz Medicare Advantage |
$8,272.19
|
| Rate for Payer: The Alliance Commercial |
$27,822.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,272.19
|
| Rate for Payer: United Healthcare PPO |
$15,696.67
|
| Rate for Payer: Wellcare Medicare |
$8,272.19
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$59,173.92
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$16,793.48 |
| Max. Negotiated Rate |
$59,173.92 |
| Rate for Payer: Aetna Managed Medicare |
$16,793.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,402.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,567.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,791.39
|
| Rate for Payer: Anthem Medicare Advantage |
$16,793.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,793.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,793.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,793.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,511.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,793.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,157.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,793.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,793.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,793.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,793.48
|
| Rate for Payer: NAPHCARE Commercial |
$25,190.22
|
| Rate for Payer: Quartz Medicare Advantage |
$16,793.48
|
| Rate for Payer: The Alliance Commercial |
$59,173.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,793.48
|
| Rate for Payer: United Healthcare PPO |
$33,598.96
|
| Rate for Payer: Wellcare Medicare |
$16,793.48
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,970.08
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$5,346.75 |
| Max. Negotiated Rate |
$19,970.08 |
| Rate for Payer: Aetna Managed Medicare |
$5,346.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,789.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,569.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,041.92
|
| Rate for Payer: Anthem Medicare Advantage |
$5,346.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,346.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,346.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,346.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,147.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,346.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,402.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,346.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,346.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,346.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,346.75
|
| Rate for Payer: NAPHCARE Commercial |
$8,020.13
|
| Rate for Payer: Quartz Medicare Advantage |
$5,346.75
|
| Rate for Payer: The Alliance Commercial |
$19,970.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,346.75
|
| Rate for Payer: United Healthcare PPO |
$11,212.81
|
| Rate for Payer: Wellcare Medicare |
$5,346.75
|
|
|
RETINAL DETACHMENT/REATTACHMENT, INTRAOCULAR GAS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
RETINAL DETACHMENT/REATTACHMENT, INTRAOCULAR GAS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
RETRACTION CLIP CORONARY ARTERY 3.0MM STERILE 16130
|
Facility
|
OP
|
$328.00
|
|
| Hospital Charge Code |
2965339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
RETRACTION CLIP CORONARY ARTERY 3.0MM STERILE 16130
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
2965339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
RETRACTOR ALEXIS WOUND LARGE C8303
|
Facility
|
IP
|
$1,189.00
|
|
| Hospital Charge Code |
4520202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.91 |
| Max. Negotiated Rate |
$1,137.64 |
| Rate for Payer: Aetna Commercial |
$1,112.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,063.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.38
|
| Rate for Payer: Cash Price |
$356.70
|
| Rate for Payer: Cigna Commercial |
$1,137.64
|
| Rate for Payer: Health EOS Commercial |
$1,100.54
|
| Rate for Payer: HFN Commercial |
$1,137.64
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.64
|
| Rate for Payer: Quartz Beloit One Network |
$605.91
|
| Rate for Payer: Quartz Commercial |
$741.94
|
| Rate for Payer: WEA Trust Commercial |
$680.11
|
| Rate for Payer: WPS Commercial |
$915.89
|
|
|
RETRACTOR ALEXIS WOUND LARGE C8303
|
Facility
|
OP
|
$1,189.00
|
|
| Hospital Charge Code |
4520202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.24 |
| Max. Negotiated Rate |
$1,137.64 |
| Rate for Payer: Aetna Commercial |
$1,112.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,063.44
|
| Rate for Payer: Aetna Managed Medicare |
$346.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.38
|
| Rate for Payer: Cash Price |
$356.70
|
| Rate for Payer: Cigna Commercial |
$1,137.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.00
|
| Rate for Payer: Health EOS Commercial |
$1,100.54
|
| Rate for Payer: HFN Commercial |
$1,137.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.42
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: NAPHCARE Commercial |
$741.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,137.64
|
| Rate for Payer: Quartz Beloit One Network |
$605.91
|
| Rate for Payer: Quartz Commercial |
$803.76
|
| Rate for Payer: Quartz Medicare Advantage |
$741.94
|
| Rate for Payer: The Alliance Commercial |
$618.28
|
| Rate for Payer: WEA Trust Commercial |
$680.11
|
| Rate for Payer: WPS Commercial |
$915.89
|
|
|
RETRACTOR ALEXIS WOUND MEDIUM C8302
|
Facility
|
OP
|
$1,707.00
|
|
| Hospital Charge Code |
2964644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.08 |
| Max. Negotiated Rate |
$1,633.26 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.74
|
| Rate for Payer: Aetna Managed Medicare |
$497.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.90
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna Commercial |
$1,633.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.47
|
| Rate for Payer: Health EOS Commercial |
$1,580.00
|
| Rate for Payer: HFN Commercial |
$1,633.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,331.46
|
| Rate for Payer: Multiplan Commercial |
$1,420.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.26
|
| Rate for Payer: Quartz Beloit One Network |
$869.89
|
| Rate for Payer: Quartz Commercial |
$1,153.93
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.17
|
| Rate for Payer: The Alliance Commercial |
$887.64
|
| Rate for Payer: WEA Trust Commercial |
$976.40
|
| Rate for Payer: WPS Commercial |
$1,314.90
|
|
|
RETRACTOR ALEXIS WOUND MEDIUM C8302
|
Facility
|
IP
|
$1,707.00
|
|
| Hospital Charge Code |
2964644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.89 |
| Max. Negotiated Rate |
$1,633.26 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,526.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.90
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna Commercial |
$1,633.26
|
| Rate for Payer: Health EOS Commercial |
$1,580.00
|
| Rate for Payer: HFN Commercial |
$1,633.26
|
| Rate for Payer: Multiplan Commercial |
$1,420.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,633.26
|
| Rate for Payer: Quartz Beloit One Network |
$869.89
|
| Rate for Payer: Quartz Commercial |
$1,065.17
|
| Rate for Payer: WEA Trust Commercial |
$976.40
|
| Rate for Payer: WPS Commercial |
$1,314.90
|
|
|
RETRACTOR ALEXIS WOUND SMALL C8301
|
Facility
|
IP
|
$864.00
|
|
| Hospital Charge Code |
5240655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.29 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$539.14
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
