|
COIL NESTER 14-10 #G26991
|
Facility
|
OP
|
$1,791.00
|
|
| Hospital Charge Code |
2972455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.54 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$521.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.36
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.98
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,210.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.58
|
| Rate for Payer: The Alliance Commercial |
$931.32
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
COIL NESTER 14-12mm #G26992
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 14-12mm #G26992
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 4mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 4mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972429
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 6mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 6mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 8mm
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2972431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL NESTER 8mm
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2972431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
COIL TORNADO 35 10/5 #G10413
|
Facility
|
IP
|
$1,554.00
|
|
| Hospital Charge Code |
2972544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.92 |
| Max. Negotiated Rate |
$1,486.87 |
| Rate for Payer: Aetna Commercial |
$1,454.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.56
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,486.87
|
| Rate for Payer: Health EOS Commercial |
$1,438.38
|
| Rate for Payer: HFN Commercial |
$1,486.87
|
| Rate for Payer: Multiplan Commercial |
$1,292.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.87
|
| Rate for Payer: Quartz Beloit One Network |
$791.92
|
| Rate for Payer: Quartz Commercial |
$969.70
|
| Rate for Payer: WEA Trust Commercial |
$888.89
|
| Rate for Payer: WPS Commercial |
$1,197.05
|
|
|
COIL TORNADO 35 10/5 #G10413
|
Facility
|
OP
|
$1,554.00
|
|
| Hospital Charge Code |
2972544
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$1,486.87 |
| Rate for Payer: Aetna Commercial |
$1,454.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,050.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.56
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,486.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.43
|
| Rate for Payer: Health EOS Commercial |
$1,438.38
|
| Rate for Payer: HFN Commercial |
$1,486.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.12
|
| Rate for Payer: Multiplan Commercial |
$1,292.93
|
| Rate for Payer: NAPHCARE Commercial |
$969.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.87
|
| Rate for Payer: Quartz Beloit One Network |
$791.92
|
| Rate for Payer: Quartz Commercial |
$1,050.50
|
| Rate for Payer: Quartz Medicare Advantage |
$969.70
|
| Rate for Payer: The Alliance Commercial |
$808.08
|
| Rate for Payer: WEA Trust Commercial |
$888.89
|
| Rate for Payer: WPS Commercial |
$1,197.05
|
|
|
COIL TORNADO 35-8/5 (G10412)
|
Facility
|
IP
|
$1,554.00
|
|
| Hospital Charge Code |
2972545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$791.92 |
| Max. Negotiated Rate |
$1,486.87 |
| Rate for Payer: Aetna Commercial |
$1,454.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.56
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,486.87
|
| Rate for Payer: Health EOS Commercial |
$1,438.38
|
| Rate for Payer: HFN Commercial |
$1,486.87
|
| Rate for Payer: Multiplan Commercial |
$1,292.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.87
|
| Rate for Payer: Quartz Beloit One Network |
$791.92
|
| Rate for Payer: Quartz Commercial |
$969.70
|
| Rate for Payer: WEA Trust Commercial |
$888.89
|
| Rate for Payer: WPS Commercial |
$1,197.05
|
|
|
COIL TORNADO 35-8/5 (G10412)
|
Facility
|
OP
|
$1,554.00
|
|
| Hospital Charge Code |
2972545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$1,486.87 |
| Rate for Payer: Aetna Commercial |
$1,454.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.90
|
| Rate for Payer: Aetna Managed Medicare |
$452.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,050.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.56
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cigna Commercial |
$1,486.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.43
|
| Rate for Payer: Health EOS Commercial |
$1,438.38
|
| Rate for Payer: HFN Commercial |
$1,486.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.12
|
| Rate for Payer: Multiplan Commercial |
$1,292.93
|
| Rate for Payer: NAPHCARE Commercial |
$969.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.87
|
| Rate for Payer: Quartz Beloit One Network |
$791.92
|
| Rate for Payer: Quartz Commercial |
$1,050.50
|
| Rate for Payer: Quartz Medicare Advantage |
$969.70
|
| Rate for Payer: The Alliance Commercial |
$808.08
|
| Rate for Payer: WEA Trust Commercial |
$888.89
|
| Rate for Payer: WPS Commercial |
$1,197.05
|
|
|
COL/ADP
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4524657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$274.66 |
| Rate for Payer: Aetna Commercial |
$274.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$25.91
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.91
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$274.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.91
|
| Rate for Payer: Health EOS Commercial |
$263.10
|
| Rate for Payer: HFN Commercial |
$274.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.91
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$38.86
|
| Rate for Payer: Preferred Network Access Commercial |
$274.66
|
| Rate for Payer: Quartz Beloit One Network |
$127.21
|
| Rate for Payer: Quartz Commercial |
$164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$25.91
|
| Rate for Payer: The Alliance Commercial |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.91
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$113.99
|
|
|
COL/ADP
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4524657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$173.47
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
COL/ADP
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4524657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$25.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.00
|
| Rate for Payer: Anthem Medicare Advantage |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.91
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.91
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.91
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$38.86
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$187.93
|
| Rate for Payer: Quartz Medicare Advantage |
$25.91
|
| Rate for Payer: The Alliance Commercial |
$103.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.91
|
| Rate for Payer: United Healthcare PPO |
$216.84
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: Wellcare Medicare |
$25.91
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Cold Agglutinins
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
633707
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Cold Agglutinins
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
633707
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$8.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.38
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.38
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$12.57
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$8.38
|
| Rate for Payer: The Alliance Commercial |
$33.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.38
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$8.38
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Cold Agglutinins
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
633707
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$8.38
|
| Rate for Payer: Anthem Medicare Advantage |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.38
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.38
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$12.57
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$8.38
|
| Rate for Payer: The Alliance Commercial |
$33.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.38
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$36.88
|
|
|
COLD PACK NECK CONTOUR 21 L
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2970826
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
COLD PACK NECK CONTOUR 21 L
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2970826
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
COLD THERAPY POLAR CARE KNEE LARGE 10706
|
Facility
|
IP
|
$2,804.00
|
|
| Hospital Charge Code |
3872052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,428.92 |
| Max. Negotiated Rate |
$2,682.87 |
| Rate for Payer: Aetna Commercial |
$2,624.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.56
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,682.87
|
| Rate for Payer: Health EOS Commercial |
$2,595.38
|
| Rate for Payer: HFN Commercial |
$2,682.87
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.92
|
| Rate for Payer: Quartz Commercial |
$1,749.70
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
|
COLD THERAPY POLAR CARE KNEE LARGE 10706
|
Facility
|
OP
|
$2,804.00
|
|
| Hospital Charge Code |
3872052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$816.52 |
| Max. Negotiated Rate |
$2,682.87 |
| Rate for Payer: Aetna Commercial |
$2,624.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Aetna Managed Medicare |
$816.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,895.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,458.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,399.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.56
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,682.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.93
|
| Rate for Payer: Health EOS Commercial |
$2,595.38
|
| Rate for Payer: HFN Commercial |
$2,682.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.12
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.92
|
| Rate for Payer: Quartz Commercial |
$1,895.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.70
|
| Rate for Payer: The Alliance Commercial |
$1,458.08
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
|
COLD THERAPY POLAR CARE KNEE XL 10707
|
Facility
|
OP
|
$2,861.00
|
|
| Hospital Charge Code |
3872050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$833.12 |
| Max. Negotiated Rate |
$2,737.40 |
| Rate for Payer: Aetna Commercial |
$2,677.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,558.88
|
| Rate for Payer: Aetna Managed Medicare |
$833.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,934.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,487.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,428.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,576.98
|
| Rate for Payer: Cash Price |
$858.30
|
| Rate for Payer: Cigna Commercial |
$2,737.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.10
|
| Rate for Payer: Health EOS Commercial |
$2,648.14
|
| Rate for Payer: HFN Commercial |
$2,737.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,231.58
|
| Rate for Payer: Multiplan Commercial |
$2,380.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,785.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,737.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,457.97
|
| Rate for Payer: Quartz Commercial |
$1,934.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,785.26
|
| Rate for Payer: The Alliance Commercial |
$1,487.72
|
| Rate for Payer: WEA Trust Commercial |
$1,636.49
|
| Rate for Payer: WPS Commercial |
$2,203.83
|
|
|
COLD THERAPY POLAR CARE KNEE XL 10707
|
Facility
|
IP
|
$2,861.00
|
|
| Hospital Charge Code |
3872050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,457.97 |
| Max. Negotiated Rate |
$2,737.40 |
| Rate for Payer: Aetna Commercial |
$2,677.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,558.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,576.98
|
| Rate for Payer: Cash Price |
$858.30
|
| Rate for Payer: Cigna Commercial |
$2,737.40
|
| Rate for Payer: Health EOS Commercial |
$2,648.14
|
| Rate for Payer: HFN Commercial |
$2,737.40
|
| Rate for Payer: Multiplan Commercial |
$2,380.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,737.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,457.97
|
| Rate for Payer: Quartz Commercial |
$1,785.26
|
| Rate for Payer: WEA Trust Commercial |
$1,636.49
|
| Rate for Payer: WPS Commercial |
$2,203.83
|
|
