|
STRABISMUS REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960393
|
|
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
|
|
|
Straight Catheter 51701
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5879791
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| 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 |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| 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 |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| 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 |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight Catheter 51701
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5879791
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent* - Urinary catheter type:
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5877764
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| 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 |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| 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 |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| 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 |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent* - Urinary catheter type:
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5877764
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent - Urinary Catheter Type
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
2999938
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent - Urinary Catheter Type
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
2999938
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| 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 |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| 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 |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| 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 |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent* - Urinary Catheter Type:
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5510858
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Straight/Intermittent* - Urinary Catheter Type:
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
5510858
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| 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 |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| 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 |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| 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 |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
STRAIGHT PLATE LOCKING 4HL SS AR-8943C-04
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.85 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.93
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,452.28
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.82
|
| Rate for Payer: The Alliance Commercial |
$2,301.52
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
STRAIGHT PLATE LOCKING 4HL SS AR-8943C-04
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6105630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
Straitional Antibody
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Straitional Antibody
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Straitional Antibody
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
STRAP ANKLE DISTRACTOR 014407
|
Facility
|
IP
|
$941.00
|
|
| Hospital Charge Code |
2965968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.53 |
| Max. Negotiated Rate |
$900.35 |
| Rate for Payer: Aetna Commercial |
$880.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.68
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Health EOS Commercial |
$870.99
|
| Rate for Payer: HFN Commercial |
$900.35
|
| Rate for Payer: Multiplan Commercial |
$782.91
|
| Rate for Payer: Preferred Network Access Commercial |
$900.35
|
| Rate for Payer: Quartz Beloit One Network |
$479.53
|
| Rate for Payer: Quartz Commercial |
$587.18
|
| Rate for Payer: WEA Trust Commercial |
$538.25
|
| Rate for Payer: WPS Commercial |
$724.85
|
|
|
STRAP ANKLE DISTRACTOR 014407
|
Facility
|
OP
|
$941.00
|
|
| Hospital Charge Code |
2965968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.02 |
| Max. Negotiated Rate |
$900.35 |
| Rate for Payer: Aetna Commercial |
$880.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.63
|
| Rate for Payer: Aetna Managed Medicare |
$274.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$636.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$489.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.68
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.66
|
| Rate for Payer: Health EOS Commercial |
$870.99
|
| Rate for Payer: HFN Commercial |
$900.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.98
|
| Rate for Payer: Multiplan Commercial |
$782.91
|
| Rate for Payer: NAPHCARE Commercial |
$587.18
|
| Rate for Payer: Preferred Network Access Commercial |
$900.35
|
| Rate for Payer: Quartz Beloit One Network |
$479.53
|
| Rate for Payer: Quartz Commercial |
$636.12
|
| Rate for Payer: Quartz Medicare Advantage |
$587.18
|
| Rate for Payer: The Alliance Commercial |
$489.32
|
| Rate for Payer: WEA Trust Commercial |
$538.25
|
| Rate for Payer: WPS Commercial |
$724.85
|
|
|
STRAP ANKLE DISTRACTOR AR-1712
|
Facility
|
IP
|
$1,031.00
|
|
| Hospital Charge Code |
5457016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.40 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$643.34
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
STRAP ANKLE DISTRACTOR AR-1712
|
Facility
|
OP
|
$1,031.00
|
|
| Hospital Charge Code |
5457016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.23 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Aetna Managed Medicare |
$300.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.04
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.18
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: NAPHCARE Commercial |
$643.34
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$696.96
|
| Rate for Payer: Quartz Medicare Advantage |
$643.34
|
| Rate for Payer: The Alliance Commercial |
$536.12
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
STRAP CIRCUMCISION BOARD PAIR #4749
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
2973388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.46
|
| 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: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.22
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$30.58
|
| 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 |
$30.58
|
| Rate for Payer: The Alliance Commercial |
$25.48
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
STRAP CIRCUMCISION BOARD PAIR #4749
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
2973388
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
Strapping Ankle and/or Foot
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
2572820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$64.53
|
| Rate for Payer: United Healthcare Medicaid |
$28.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$68.33
|
|
|
STRAPPING MATERIAL 1 X 25 YDS #A809-20"
|
Facility
|
OP
|
$707.00
|
|
| Hospital Charge Code |
2971568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Aetna Managed Medicare |
$205.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.47
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.46
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: NAPHCARE Commercial |
$441.17
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$477.93
|
| Rate for Payer: Quartz Medicare Advantage |
$441.17
|
| Rate for Payer: The Alliance Commercial |
$367.64
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
STRAPPING MATERIAL 1 X 25 YDS #A809-20"
|
Facility
|
IP
|
$707.00
|
|
| Hospital Charge Code |
2971568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$360.29 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$441.17
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
STRAPPING MATERIAL 2 X 25 YDS #A809-21"
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2971773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$280.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.92
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| Rate for Payer: Quartz Medicare Advantage |
$601.54
|
| Rate for Payer: The Alliance Commercial |
$501.28
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
STRAPPING MATERIAL 2 X 25 YDS #A809-21"
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2971773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
