|
Special Stains 1
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Special Stains 1
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Commercial |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$205.37
|
| Rate for Payer: HFN Commercial |
$214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$214.40
|
| Rate for Payer: Quartz Beloit One Network |
$99.30
|
| Rate for Payer: Quartz Commercial |
$128.64
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Special Stains 1
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.38 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$169.26
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Special Stains 2
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Special Stains 2
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Commercial |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Special Stains 2
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Special Treatment Procedure
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.48 |
| Max. Negotiated Rate |
$2,325.94 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Aetna Managed Medicare |
$581.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,269.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,815.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,724.57
|
| Rate for Payer: Anthem Medicare Advantage |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.48
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.48
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,163.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.48
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: NAPHCARE Commercial |
$872.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$952.48
|
| Rate for Payer: Quartz Medicare Advantage |
$581.48
|
| Rate for Payer: The Alliance Commercial |
$2,325.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.48
|
| Rate for Payer: United Healthcare PPO |
$1,099.02
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: Wellcare Medicare |
$581.48
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
Special Treatment Procedure
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$718.03 |
| Max. Negotiated Rate |
$1,348.13 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$879.22
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
Special Treatment Procedure 77470
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
5516739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$725.30 |
| Rate for Payer: Aetna Commercial |
$498.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.67
|
| Rate for Payer: Aetna Managed Medicare |
$145.06
|
| Rate for Payer: Anthem Medicare Advantage |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$145.06
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$498.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.06
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$498.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$145.06
|
| Rate for Payer: Multiplan Commercial |
$420.16
|
| Rate for Payer: NAPHCARE Commercial |
$217.59
|
| Rate for Payer: Preferred Network Access Commercial |
$498.94
|
| Rate for Payer: Quartz Beloit One Network |
$231.09
|
| Rate for Payer: Quartz Commercial |
$299.36
|
| Rate for Payer: Quartz Medicare Advantage |
$145.06
|
| Rate for Payer: The Alliance Commercial |
$551.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.06
|
| Rate for Payer: WEA Trust Commercial |
$288.86
|
| Rate for Payer: WPS Commercial |
$725.30
|
|
|
Specialty bed: Bariatric - Devices and Equipment
|
Facility
|
IP
|
$1,792.00
|
|
| Hospital Charge Code |
3031054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$913.20 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,118.21
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
Specialty bed: Bariatric - Devices and Equipment
|
Facility
|
OP
|
$1,792.00
|
|
| Hospital Charge Code |
3031054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
|
Specialty bed: Bariatric w/ Turn Assist - Devices and Equipment
|
Facility
|
IP
|
$1,164.00
|
|
| Hospital Charge Code |
3031053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$593.17 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$726.34
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
Specialty bed: Bariatric w/ Turn Assist - Devices and Equipment
|
Facility
|
OP
|
$1,164.00
|
|
| Hospital Charge Code |
3031053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$338.96 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Aetna Managed Medicare |
$338.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$786.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.45
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$907.92
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: NAPHCARE Commercial |
$726.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$786.86
|
| Rate for Payer: Quartz Medicare Advantage |
$726.34
|
| Rate for Payer: The Alliance Commercial |
$605.28
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
Specialty bed: Critical Care - Devices and Equipment
|
Facility
|
IP
|
$2,478.00
|
|
| Hospital Charge Code |
3031052
|
| Min. Negotiated Rate |
$1,262.79 |
| Max. Negotiated Rate |
$2,370.95 |
| Rate for Payer: Aetna Commercial |
$2,319.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.87
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,370.95
|
| Rate for Payer: Health EOS Commercial |
$2,293.64
|
| Rate for Payer: HFN Commercial |
$2,370.95
|
| Rate for Payer: Multiplan Commercial |
$2,061.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.79
|
| Rate for Payer: Quartz Commercial |
$1,546.27
|
| Rate for Payer: WEA Trust Commercial |
$1,417.42
|
| Rate for Payer: WPS Commercial |
$1,908.80
|
|
|
Specialty bed: Critical Care - Devices and Equipment
|
Facility
|
OP
|
$2,478.00
|
|
| Hospital Charge Code |
3031052
|
| Min. Negotiated Rate |
$721.59 |
| Max. Negotiated Rate |
$2,370.95 |
| Rate for Payer: Aetna Commercial |
$2,319.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,216.32
|
| Rate for Payer: Aetna Managed Medicare |
$721.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,288.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,365.87
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,370.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.20
|
| Rate for Payer: Health EOS Commercial |
$2,293.64
|
| Rate for Payer: HFN Commercial |
$2,370.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.84
|
| Rate for Payer: Multiplan Commercial |
$2,061.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.79
|
| Rate for Payer: Quartz Commercial |
$1,675.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.27
|
| Rate for Payer: The Alliance Commercial |
$1,288.56
|
| Rate for Payer: WEA Trust Commercial |
$1,417.42
|
| Rate for Payer: WPS Commercial |
$1,908.80
|
|
|
Specialty bed: Fluid air bed - Devices and Equipment
|
Facility
|
IP
|
$1,793.00
|
|
| Hospital Charge Code |
3031051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$913.71 |
| Max. Negotiated Rate |
$1,715.54 |
| Rate for Payer: Aetna Commercial |
$1,678.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,603.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$988.30
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cigna Commercial |
$1,715.54
|
| Rate for Payer: Health EOS Commercial |
$1,659.60
|
| Rate for Payer: HFN Commercial |
$1,715.54
|
| Rate for Payer: Multiplan Commercial |
$1,491.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,715.54
|
| Rate for Payer: Quartz Beloit One Network |
$913.71
|
| Rate for Payer: Quartz Commercial |
$1,118.83
|
| Rate for Payer: WEA Trust Commercial |
$1,025.60
|
| Rate for Payer: WPS Commercial |
$1,381.15
|
|
|
Specialty bed: Fluid air bed - Devices and Equipment
|
Facility
|
OP
|
$1,793.00
|
|
| Hospital Charge Code |
3031051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$522.12 |
| Max. Negotiated Rate |
$1,715.54 |
| Rate for Payer: Aetna Commercial |
$1,678.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,603.66
|
| Rate for Payer: Aetna Managed Medicare |
$522.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,212.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$932.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$895.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$988.30
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cigna Commercial |
$1,715.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,043.53
|
| Rate for Payer: Health EOS Commercial |
$1,659.60
|
| Rate for Payer: HFN Commercial |
$1,715.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,398.54
|
| Rate for Payer: Multiplan Commercial |
$1,491.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,715.54
|
| Rate for Payer: Quartz Beloit One Network |
$913.71
|
| Rate for Payer: Quartz Commercial |
$1,212.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.83
|
| Rate for Payer: The Alliance Commercial |
$932.36
|
| Rate for Payer: WEA Trust Commercial |
$1,025.60
|
| Rate for Payer: WPS Commercial |
$1,381.15
|
|
|
Specialty bed: MedSurg - Devices and Equipment
|
Facility
|
IP
|
$1,164.00
|
|
| Hospital Charge Code |
3031050
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$593.17 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$726.34
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
Specialty bed: MedSurg - Devices and Equipment
|
Facility
|
OP
|
$1,164.00
|
|
| Hospital Charge Code |
3031050
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$338.96 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Aetna Managed Medicare |
$338.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$786.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$605.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.45
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$907.92
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: NAPHCARE Commercial |
$726.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$786.86
|
| Rate for Payer: Quartz Medicare Advantage |
$726.34
|
| Rate for Payer: The Alliance Commercial |
$605.28
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
SPECIMEN TRAP STERILE 40cc
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2974707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
SPECIMEN TRAP STERILE 40cc
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2974707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Spec RT Port Plan Particles
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
3040384
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$826.57 |
| Max. Negotiated Rate |
$1,551.93 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,012.13
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
Spec RT Port Plan Particles
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
3040384
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$1,576.18 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,096.47
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$1,265.16
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
Spectral Doppler Complete 93320
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5381789
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$205.34 |
| Max. Negotiated Rate |
$1,083.10 |
| Rate for Payer: Aetna Commercial |
$1,059.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.46
|
| Rate for Payer: Aetna Managed Medicare |
$329.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$588.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$623.96
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,083.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$658.82
|
| Rate for Payer: Health EOS Commercial |
$1,047.78
|
| Rate for Payer: HFN Commercial |
$1,083.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$882.96
|
| Rate for Payer: Multiplan Commercial |
$941.82
|
| Rate for Payer: NAPHCARE Commercial |
$706.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.10
|
| Rate for Payer: Quartz Beloit One Network |
$576.87
|
| Rate for Payer: Quartz Commercial |
$765.23
|
| Rate for Payer: Quartz Medicare Advantage |
$706.37
|
| Rate for Payer: The Alliance Commercial |
$205.34
|
| Rate for Payer: United Healthcare PPO |
$882.96
|
| Rate for Payer: WEA Trust Commercial |
$647.50
|
| Rate for Payer: WPS Commercial |
$871.98
|
|
|
Spectral Doppler Complete 93320
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5381789
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$576.87 |
| Max. Negotiated Rate |
$1,083.10 |
| Rate for Payer: Aetna Commercial |
$1,059.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$623.96
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,083.10
|
| Rate for Payer: Health EOS Commercial |
$1,047.78
|
| Rate for Payer: HFN Commercial |
$1,083.10
|
| Rate for Payer: Multiplan Commercial |
$941.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.10
|
| Rate for Payer: Quartz Beloit One Network |
$576.87
|
| Rate for Payer: Quartz Commercial |
$706.37
|
| Rate for Payer: WEA Trust Commercial |
$647.50
|
| Rate for Payer: WPS Commercial |
$871.98
|
|
