|
Ceruloplasmin
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$11.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.54
|
| Rate for Payer: Anthem Medicare Advantage |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.17
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.17
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$16.75
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$11.17
|
| Rate for Payer: The Alliance Commercial |
$44.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.17
|
| Rate for Payer: United Healthcare PPO |
$150.54
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: Wellcare Medicare |
$11.17
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
Cerv flexible non-adjustable L0120
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Cerv flexible non-adjustable L0120
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Cerv flexible non-adjustable L0120
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
3408197
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$97.47 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$33.81
|
| Rate for Payer: Anthem Medicare Advantage |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.81
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.81
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$50.72
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$33.81
|
| Rate for Payer: The Alliance Commercial |
$92.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.81
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$59.17
|
|
|
CERVICAL ARTHRODESIS
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959816
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
CERVICAL ARTHRODESIS
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959816
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
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 |
$48.92 |
| Max. Negotiated Rate |
$547.21 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$547.21
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$48.92 |
| Max. Negotiated Rate |
$547.21 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$48.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$104.83
|
| Rate for Payer: The Alliance Commercial |
$547.21
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Cervical Collars
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3040305
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Cervical Collars
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
3040305
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Cervical collar, soft applied - Treatments Done
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
3002555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Cervical collar, soft applied - Treatments Done
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
3002555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Cervical collar, soft applied - Triage Treatments
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
2999899
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Cervical collar, soft applied - Triage Treatments
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
2999899
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Cervical Immobilization Device
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Cervical Immobilization Device
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
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
|
|
|
Cervical semi-rigid adjustab L0140
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$76.50
|
| Rate for Payer: Anthem Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.50
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$114.75
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$76.50
|
| Rate for Payer: The Alliance Commercial |
$210.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$133.88
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$138.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.45
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$296.40
|
| Rate for Payer: The Alliance Commercial |
$306.01
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$82,048.72
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$23,068.59 |
| Max. Negotiated Rate |
$82,048.72 |
| Rate for Payer: Aetna Managed Medicare |
$23,068.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,281.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,271.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,810.94
|
| Rate for Payer: Anthem Medicare Advantage |
$23,068.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,068.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,068.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,068.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,964.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,068.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,935.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,068.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,068.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,068.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,068.59
|
| Rate for Payer: NAPHCARE Commercial |
$34,602.89
|
| Rate for Payer: Quartz Medicare Advantage |
$23,068.59
|
| Rate for Payer: The Alliance Commercial |
$82,048.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,068.59
|
| Rate for Payer: United Healthcare PPO |
$46,660.57
|
| Rate for Payer: Wellcare Medicare |
$23,068.59
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$136,340.88
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$37,485.92 |
| Max. Negotiated Rate |
$136,340.88 |
| Rate for Payer: Aetna Managed Medicare |
$37,485.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105,358.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80,756.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76,723.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37,485.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,485.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,485.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,485.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85,170.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,485.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99,757.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,485.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,485.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,485.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,485.92
|
| Rate for Payer: NAPHCARE Commercial |
$56,228.87
|
| Rate for Payer: Quartz Medicare Advantage |
$37,485.92
|
| Rate for Payer: The Alliance Commercial |
$136,340.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,485.92
|
| Rate for Payer: United Healthcare PPO |
$77,662.35
|
| Rate for Payer: Wellcare Medicare |
$37,485.92
|
|
