|
Cephalic Version - Individual Charges
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3040450
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$332.12 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$216.60
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 559MM 2232-01-18
|
Facility
IP
|
$3,859.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4434533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,890.91 |
| Max. Negotiated Rate |
$3,550.28 |
| Rate for Payer: Aetna Commercial |
$3,473.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,045.27
|
| Rate for Payer: Cash Price |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$3,550.28
|
| Rate for Payer: Health EOS Commercial |
$3,434.51
|
| Rate for Payer: HFN Commercial |
$3,550.28
|
| Rate for Payer: Multiplan Commercial |
$3,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,315.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,550.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.91
|
| Rate for Payer: Quartz Commercial |
$2,315.40
|
| Rate for Payer: WEA Trust Commercial |
$2,122.45
|
| Rate for Payer: WPS Commercial |
$2,858.36
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 559MM 2232-01-18
|
Facility
OP
|
$3,859.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4434533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,080.52 |
| Max. Negotiated Rate |
$3,550.28 |
| Rate for Payer: Aetna Commercial |
$3,473.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,318.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,508.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,929.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,852.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,045.27
|
| Rate for Payer: Cash Price |
$1,157.70
|
| Rate for Payer: Cash Price |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$3,550.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,159.50
|
| Rate for Payer: Health EOS Commercial |
$3,434.51
|
| Rate for Payer: HFN Commercial |
$3,550.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,894.25
|
| Rate for Payer: Multiplan Commercial |
$3,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,315.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,550.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.91
|
| Rate for Payer: Quartz Commercial |
$2,508.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,315.40
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$2,122.45
|
| Rate for Payer: WPS Commercial |
$2,858.36
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 635MM 2232-04-18
|
Facility
IP
|
$4,077.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4220574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.73 |
| Max. Negotiated Rate |
$3,750.84 |
| Rate for Payer: Aetna Commercial |
$3,669.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,160.81
|
| Rate for Payer: Cash Price |
$1,223.10
|
| Rate for Payer: Cigna Commercial |
$3,750.84
|
| Rate for Payer: Health EOS Commercial |
$3,628.53
|
| Rate for Payer: HFN Commercial |
$3,750.84
|
| Rate for Payer: Multiplan Commercial |
$3,261.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,446.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,750.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,997.73
|
| Rate for Payer: Quartz Commercial |
$2,446.20
|
| Rate for Payer: WEA Trust Commercial |
$2,242.35
|
| Rate for Payer: WPS Commercial |
$3,019.83
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 635MM 2232-04-18
|
Facility
OP
|
$4,077.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4220574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.56 |
| Max. Negotiated Rate |
$3,750.84 |
| Rate for Payer: Aetna Commercial |
$3,669.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,506.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,141.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,650.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,038.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,956.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,160.81
|
| Rate for Payer: Cash Price |
$1,223.10
|
| Rate for Payer: Cash Price |
$1,223.10
|
| Rate for Payer: Cigna Commercial |
$3,750.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,281.49
|
| Rate for Payer: Health EOS Commercial |
$3,628.53
|
| Rate for Payer: HFN Commercial |
$3,750.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,057.75
|
| Rate for Payer: Multiplan Commercial |
$3,261.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,446.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,750.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,997.73
|
| Rate for Payer: Quartz Commercial |
$2,650.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,446.20
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: WEA Trust Commercial |
$2,242.35
|
| Rate for Payer: WPS Commercial |
$3,019.83
|
|
|
CERCLAGE SUTURE TENSIONER DISP AR-7820
|
Facility
IP
|
$2,705.00
|
|
| Hospital Charge Code |
6166115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.45 |
| Max. Negotiated Rate |
$2,488.60 |
| Rate for Payer: Aetna Commercial |
$2,434.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.65
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,488.60
|
| Rate for Payer: Health EOS Commercial |
$2,407.45
|
| Rate for Payer: HFN Commercial |
$2,488.60
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.45
|
| Rate for Payer: Quartz Commercial |
$1,623.00
|
| Rate for Payer: WEA Trust Commercial |
$1,487.75
|
| Rate for Payer: WPS Commercial |
$2,003.59
|
|
|
CERCLAGE SUTURE TENSIONER DISP AR-7820
|
Facility
OP
|
$2,705.00
|
|
| Hospital Charge Code |
6166115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$757.40 |
| Max. Negotiated Rate |
$10,820.00 |
| Rate for Payer: Aetna Commercial |
$2,434.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,326.30
|
| Rate for Payer: Aetna Managed Medicare |
$757.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,352.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,433.65
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,488.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,513.72
|
| Rate for Payer: Health EOS Commercial |
$2,407.45
|
| Rate for Payer: HFN Commercial |
$2,488.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.75
|
| Rate for Payer: Multiplan Commercial |
$2,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,488.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.45
|
| Rate for Payer: Quartz Commercial |
$1,758.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.00
|
| Rate for Payer: The Alliance Commercial |
$10,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,487.75
|
| Rate for Payer: WPS Commercial |
$2,003.59
|
|
|
CERCLAGE WIRE 0.6MM X 175MM PRCUT 291.240.98
|
Facility
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$147.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
CERCLAGE WIRE 0.6MM X 175MM PRCUT 291.240.98
|
Facility
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Cerebrospinal Fluid Culture
|
Professional
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$37.93
|
|
|
Cerebrospinal Fluid Culture
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Cerebrospinal Fluid Culture
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Ceruloplasmin
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.83
|
| Rate for Payer: Anthem Medicaid |
$11.10
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.74
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.10
|
| Rate for Payer: Dean Health Medicaid |
$11.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.10
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$125.45
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$772.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare PPO |
$144.75
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: WMAP Medicaid |
$11.10
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
Ceruloplasmin
|
Professional
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$183.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.74
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.35
|
| Rate for Payer: Quartz Beloit One Network |
$84.92
|
| Rate for Payer: Quartz Commercial |
$110.01
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$42.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$47.26
|
|
|
Ceruloplasmin
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$177.56 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$115.80
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$115.80
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
Cerv flexible non-adjustable L0120
|
Professional
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$93.72 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.72
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cerv flexible non-adjustable L0120
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cerv flexible non-adjustable L0120
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
CERVICAL ARTHRODESIS
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959816
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
CERVICAL ARTHRODESIS
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959816
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
Cervical collar, hard applied* - Treatments Done
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
HCPCS L0150
|
| Hospital Charge Code |
3002556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Cervical collar, hard applied* - Treatments Done
|
Facility
IP
|
$168.00
|
|
|
Service Code
|
HCPCS L0150
|
| Hospital Charge Code |
3002556
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Cervical collar, hard applied - Triage Treatments
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
HCPCS L0150
|
| Hospital Charge Code |
2999900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$100.80
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Cervical collar, hard applied - Triage Treatments
|
Facility
IP
|
$168.00
|
|
|
Service Code
|
HCPCS L0150
|
| Hospital Charge Code |
2999900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Cervical Collars
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
3040305
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
