|
Cell Count w/ Diff Body Fluid
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Cell Count w/ Diff Body Fluid
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00673
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$8,768.31
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$7,788.56 |
| Max. Negotiated Rate |
$8,768.31 |
| Rate for Payer: Anthem Medicaid |
$8,396.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,396.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,396.14
|
| Rate for Payer: Dean Health Medicaid |
$8,396.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,788.56
|
| Rate for Payer: Managed Health Services Medicaid |
$8,768.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,396.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,396.14
|
| Rate for Payer: United Healthcare Medicaid |
$8,396.14
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$16,747.47
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$14,876.15 |
| Max. Negotiated Rate |
$16,747.47 |
| Rate for Payer: Anthem Medicaid |
$16,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,036.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,036.63
|
| Rate for Payer: Dean Health Medicaid |
$16,036.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,876.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16,747.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,036.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,036.63
|
| Rate for Payer: United Healthcare Medicaid |
$16,036.63
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$4,208.79
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$3,738.51 |
| Max. Negotiated Rate |
$4,208.79 |
| Rate for Payer: Anthem Medicaid |
$4,030.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,030.15
|
| Rate for Payer: Dean Health Medicaid |
$4,030.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,738.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4,208.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,030.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,030.15
|
| Rate for Payer: United Healthcare Medicaid |
$4,030.15
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$41,461.68
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$11,391.38 |
| Max. Negotiated Rate |
$41,461.68 |
| Rate for Payer: Aetna Managed Medicare |
$11,391.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,011.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,770.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,583.21
|
| Rate for Payer: Anthem Medicare Advantage |
$11,391.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,391.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,391.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,391.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,069.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,391.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,166.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,391.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,391.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,391.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,391.38
|
| Rate for Payer: NAPHCARE Commercial |
$17,087.07
|
| Rate for Payer: Quartz Medicare Advantage |
$11,391.38
|
| Rate for Payer: The Alliance Commercial |
$41,461.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,391.38
|
| Rate for Payer: United Healthcare PPO |
$23,485.01
|
| Rate for Payer: Wellcare Medicare |
$11,391.38
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$24,794.64
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$7,176.30 |
| Max. Negotiated Rate |
$24,794.64 |
| Rate for Payer: Aetna Managed Medicare |
$7,176.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,002.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,565.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,837.83
|
| Rate for Payer: Anthem Medicare Advantage |
$7,176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,176.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,176.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,361.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,176.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,941.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,176.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,176.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,176.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,176.30
|
| Rate for Payer: NAPHCARE Commercial |
$10,764.45
|
| Rate for Payer: Quartz Medicare Advantage |
$7,176.30
|
| Rate for Payer: The Alliance Commercial |
$24,794.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,176.30
|
| Rate for Payer: United Healthcare PPO |
$13,967.86
|
| Rate for Payer: Wellcare Medicare |
$7,176.30
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,388.33 |
| Max. Negotiated Rate |
$6,361.76 |
| Rate for Payer: Aetna Commercial |
$6,223.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,946.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,664.93
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,361.76
|
| Rate for Payer: Health EOS Commercial |
$6,154.31
|
| Rate for Payer: HFN Commercial |
$6,361.76
|
| Rate for Payer: Multiplan Commercial |
$5,531.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,361.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.33
|
| Rate for Payer: Quartz Commercial |
$4,148.98
|
| Rate for Payer: WEA Trust Commercial |
$3,803.23
|
| Rate for Payer: WPS Commercial |
$5,121.72
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
OP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,936.19 |
| Max. Negotiated Rate |
$6,361.76 |
| Rate for Payer: Aetna Commercial |
$6,223.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,946.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,936.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,494.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,457.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,319.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,664.93
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,361.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,869.72
|
| Rate for Payer: Health EOS Commercial |
$6,154.31
|
| Rate for Payer: HFN Commercial |
$6,361.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,186.22
|
| Rate for Payer: Multiplan Commercial |
$5,531.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,148.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,361.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.33
|
| Rate for Payer: Quartz Commercial |
$4,494.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,148.98
|
| Rate for Payer: The Alliance Commercial |
$3,457.48
|
| Rate for Payer: WEA Trust Commercial |
$3,803.23
|
| Rate for Payer: WPS Commercial |
$5,121.72
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
|
IP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,300.51 |
| Max. Negotiated Rate |
$8,074.44 |
| Rate for Payer: Aetna Commercial |
$7,898.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,547.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,651.58
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$8,074.44
|
| Rate for Payer: Health EOS Commercial |
$7,811.14
|
| Rate for Payer: HFN Commercial |
$8,074.44
|
| Rate for Payer: Multiplan Commercial |
$7,021.25
|
| Rate for Payer: Preferred Network Access Commercial |
$8,074.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,300.51
|
| Rate for Payer: Quartz Commercial |
$5,265.94
|
| Rate for Payer: WEA Trust Commercial |
$4,827.11
|
| Rate for Payer: WPS Commercial |
$6,500.56
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
|
OP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,457.44 |
| Max. Negotiated Rate |
$8,074.44 |
| Rate for Payer: Aetna Commercial |
$7,898.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,547.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,704.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,388.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,212.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,651.58
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$8,074.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,911.50
|
| Rate for Payer: Health EOS Commercial |
$7,811.14
|
| Rate for Payer: HFN Commercial |
$8,074.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,582.42
|
| Rate for Payer: Multiplan Commercial |
$7,021.25
|
| Rate for Payer: NAPHCARE Commercial |
$5,265.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,074.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,300.51
|
| Rate for Payer: Quartz Commercial |
$5,704.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5,265.94
|
| Rate for Payer: The Alliance Commercial |
$4,388.28
|
| Rate for Payer: WEA Trust Commercial |
$4,827.11
|
| Rate for Payer: WPS Commercial |
$6,500.56
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
OP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.18 |
| Max. Negotiated Rate |
$2,024.59 |
| Rate for Payer: Aetna Commercial |
$1,980.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.55
|
| Rate for Payer: Aetna Managed Medicare |
$616.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,430.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.34
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$2,024.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,231.51
|
| Rate for Payer: Health EOS Commercial |
$1,958.57
|
| Rate for Payer: HFN Commercial |
$2,024.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.31
|
| Rate for Payer: Quartz Commercial |
$1,430.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,320.38
|
| Rate for Payer: The Alliance Commercial |
$1,100.32
|
| Rate for Payer: WEA Trust Commercial |
$1,210.35
|
| Rate for Payer: WPS Commercial |
$1,629.95
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
IP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.31 |
| Max. Negotiated Rate |
$2,024.59 |
| Rate for Payer: Aetna Commercial |
$1,980.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.34
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$2,024.59
|
| Rate for Payer: Health EOS Commercial |
$1,958.57
|
| Rate for Payer: HFN Commercial |
$2,024.59
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.31
|
| Rate for Payer: Quartz Commercial |
$1,320.38
|
| Rate for Payer: WEA Trust Commercial |
$1,210.35
|
| Rate for Payer: WPS Commercial |
$1,629.95
|
|
|
CEMENT MIXING SYSTEM W/O NOZZLE REVOLUTION 0606-553-000
|
Facility
|
OP
|
$1,440.00
|
|
| Hospital Charge Code |
2962895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.33 |
| Max. Negotiated Rate |
$1,377.79 |
| Rate for Payer: Aetna Commercial |
$1,347.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.94
|
| Rate for Payer: Aetna Managed Medicare |
$419.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.73
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,377.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.08
|
| Rate for Payer: Health EOS Commercial |
$1,332.86
|
| Rate for Payer: HFN Commercial |
$1,377.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,123.20
|
| Rate for Payer: Multiplan Commercial |
$1,198.08
|
| Rate for Payer: NAPHCARE Commercial |
$898.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.79
|
| Rate for Payer: Quartz Beloit One Network |
$733.82
|
| Rate for Payer: Quartz Commercial |
$973.44
|
| Rate for Payer: Quartz Medicare Advantage |
$898.56
|
| Rate for Payer: The Alliance Commercial |
$748.80
|
| Rate for Payer: WEA Trust Commercial |
$823.68
|
| Rate for Payer: WPS Commercial |
$1,109.23
|
|
|
CEMENT MIXING SYSTEM W/O NOZZLE REVOLUTION 0606-553-000
|
Facility
|
IP
|
$1,440.00
|
|
| Hospital Charge Code |
2962895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$1,377.79 |
| Rate for Payer: Aetna Commercial |
$1,347.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.73
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,377.79
|
| Rate for Payer: Health EOS Commercial |
$1,332.86
|
| Rate for Payer: HFN Commercial |
$1,377.79
|
| Rate for Payer: Multiplan Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.79
|
| Rate for Payer: Quartz Beloit One Network |
$733.82
|
| Rate for Payer: Quartz Commercial |
$898.56
|
| Rate for Payer: WEA Trust Commercial |
$823.68
|
| Rate for Payer: WPS Commercial |
$1,109.23
|
|
|
Central Line/ CVAD - blood drawn - Central IV Activity:
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
5502701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
Central Line/ CVAD - blood drawn - Central IV Activity:
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
5502701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| 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 |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| 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 |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| 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 |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
# Central Line Missed Attempts
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.75 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Aetna Managed Medicare |
$494.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,148.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$883.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$848.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.82
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,325.22
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,060.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,148.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,060.18
|
| Rate for Payer: The Alliance Commercial |
$883.48
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
# Central Line Missed Attempts
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.81 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,060.18
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$159.16
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
CENTRAL POST MODULAR GLENOID 30MM AR-9561-30P
|
Facility
|
OP
|
$6,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,962.11 |
| Max. Negotiated Rate |
$6,446.92 |
| Rate for Payer: Aetna Commercial |
$6,306.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,962.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,554.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,363.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.99
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,446.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,921.52
|
| Rate for Payer: Health EOS Commercial |
$6,236.69
|
| Rate for Payer: HFN Commercial |
$6,446.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,255.64
|
| Rate for Payer: Multiplan Commercial |
$5,606.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,446.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.68
|
| Rate for Payer: Quartz Commercial |
$4,554.89
|
| Rate for Payer: Quartz Medicare Advantage |
$4,204.51
|
| Rate for Payer: The Alliance Commercial |
$3,503.76
|
| Rate for Payer: WEA Trust Commercial |
$3,854.14
|
| Rate for Payer: WPS Commercial |
$5,190.28
|
|
|
CENTRAL POST MODULAR GLENOID 30MM AR-9561-30P
|
Facility
|
IP
|
$6,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.68 |
| Max. Negotiated Rate |
$6,446.92 |
| Rate for Payer: Aetna Commercial |
$6,306.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.99
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,446.92
|
| Rate for Payer: Health EOS Commercial |
$6,236.69
|
| Rate for Payer: HFN Commercial |
$6,446.92
|
| Rate for Payer: Multiplan Commercial |
$5,606.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,446.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.68
|
| Rate for Payer: Quartz Commercial |
$4,204.51
|
| Rate for Payer: WEA Trust Commercial |
$3,854.14
|
| Rate for Payer: WPS Commercial |
$5,190.28
|
|
