|
COLD THERAPY POLAR CARE SHOULDER LARGE 10711
|
Facility
|
IP
|
$2,363.00
|
|
| Hospital Charge Code |
3872051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,204.18 |
| Max. Negotiated Rate |
$2,260.92 |
| Rate for Payer: Aetna Commercial |
$2,211.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,113.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,302.49
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cigna Commercial |
$2,260.92
|
| Rate for Payer: Health EOS Commercial |
$2,187.19
|
| Rate for Payer: HFN Commercial |
$2,260.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,260.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.18
|
| Rate for Payer: Quartz Commercial |
$1,474.51
|
| Rate for Payer: WEA Trust Commercial |
$1,351.64
|
| Rate for Payer: WPS Commercial |
$1,820.22
|
|
|
COLD THERAPY POLAR CARE SHOULDER LARGE 10711
|
Facility
|
OP
|
$2,363.00
|
|
| Hospital Charge Code |
3872051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.11 |
| Max. Negotiated Rate |
$2,260.92 |
| Rate for Payer: Aetna Commercial |
$2,211.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,113.47
|
| Rate for Payer: Aetna Managed Medicare |
$688.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,597.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,228.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,179.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,302.49
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cigna Commercial |
$2,260.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,375.27
|
| Rate for Payer: Health EOS Commercial |
$2,187.19
|
| Rate for Payer: HFN Commercial |
$2,260.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,843.14
|
| Rate for Payer: Multiplan Commercial |
$1,966.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,474.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,260.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.18
|
| Rate for Payer: Quartz Commercial |
$1,597.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,474.51
|
| Rate for Payer: The Alliance Commercial |
$1,228.76
|
| Rate for Payer: WEA Trust Commercial |
$1,351.64
|
| Rate for Payer: WPS Commercial |
$1,820.22
|
|
|
COLD THERAPY POLAR CARE SHOULDER XL 10712
|
Facility
|
IP
|
$2,470.00
|
|
| Hospital Charge Code |
3872049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,258.71 |
| Max. Negotiated Rate |
$2,363.30 |
| Rate for Payer: Aetna Commercial |
$2,311.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,209.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,361.46
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,363.30
|
| Rate for Payer: Health EOS Commercial |
$2,286.23
|
| Rate for Payer: HFN Commercial |
$2,363.30
|
| Rate for Payer: Multiplan Commercial |
$2,055.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,258.71
|
| Rate for Payer: Quartz Commercial |
$1,541.28
|
| Rate for Payer: WEA Trust Commercial |
$1,412.84
|
| Rate for Payer: WPS Commercial |
$1,902.64
|
|
|
COLD THERAPY POLAR CARE SHOULDER XL 10712
|
Facility
|
OP
|
$2,470.00
|
|
| Hospital Charge Code |
3872049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$719.26 |
| Max. Negotiated Rate |
$2,363.30 |
| Rate for Payer: Aetna Commercial |
$2,311.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,209.17
|
| Rate for Payer: Aetna Managed Medicare |
$719.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,669.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,284.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,233.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,361.46
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,363.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.54
|
| Rate for Payer: Health EOS Commercial |
$2,286.23
|
| Rate for Payer: HFN Commercial |
$2,363.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,926.60
|
| Rate for Payer: Multiplan Commercial |
$2,055.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,541.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,258.71
|
| Rate for Payer: Quartz Commercial |
$1,669.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,541.28
|
| Rate for Payer: The Alliance Commercial |
$1,284.40
|
| Rate for Payer: WEA Trust Commercial |
$1,412.84
|
| Rate for Payer: WPS Commercial |
$1,902.64
|
|
|
Collagen Type I C-Telopeptide
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
1038948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.25
|
| Rate for Payer: Anthem Medicare Advantage |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.43
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.43
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.43
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$29.14
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$325.83
|
| Rate for Payer: Quartz Medicare Advantage |
$19.43
|
| Rate for Payer: The Alliance Commercial |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.43
|
| Rate for Payer: United Healthcare PPO |
$375.96
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: Wellcare Medicare |
$19.43
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
Collagen Type I C-Telopeptide
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
1038948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$476.22 |
| Rate for Payer: Aetna Commercial |
$476.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.43
|
| Rate for Payer: Anthem Medicare Advantage |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.43
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$476.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.43
|
| Rate for Payer: Health EOS Commercial |
$456.16
|
| Rate for Payer: HFN Commercial |
$476.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.43
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$29.14
|
| Rate for Payer: Preferred Network Access Commercial |
$476.22
|
| Rate for Payer: Quartz Beloit One Network |
$220.56
|
| Rate for Payer: Quartz Commercial |
$285.73
|
| Rate for Payer: Quartz Medicare Advantage |
$19.43
|
| Rate for Payer: The Alliance Commercial |
$76.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.43
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$85.48
|
|
|
Collagen Type I C-Telopeptide
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
1038948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$461.18 |
| Rate for Payer: Aetna Commercial |
$451.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.68
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$461.18
|
| Rate for Payer: Health EOS Commercial |
$446.14
|
| Rate for Payer: HFN Commercial |
$461.18
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: Preferred Network Access Commercial |
$461.18
|
| Rate for Payer: Quartz Beloit One Network |
$245.63
|
| Rate for Payer: Quartz Commercial |
$300.77
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$371.28
|
|
|
COLLAR CERVICAL 0-6 MONTHS #929200
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERVICAL 0-6 MONTHS #929200
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERVICAL 2-6 YEARS #929202
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972057
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERVICAL 2-6 YEARS #929202
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972057
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERVICAL 6-12 YEARS #929195
|
Facility
|
OP
|
$1,103.00
|
|
| Hospital Charge Code |
2972027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$745.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$573.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$550.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
COLLAR CERVICAL 6-12 YEARS #929195
|
Facility
|
IP
|
$1,103.00
|
|
| Hospital Charge Code |
2972027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
COLLAR CERVICAL 6MONTHS-2YEARS #929201
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972056
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERVICAL 6MONTHS-2YEARS #929201
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972056
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
COLLAR CERV RIGID LOW PROFILE ADULT 1.75IN 1044-82
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
5349485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
COLLAR CERV RIGID LOW PROFILE ADULT 1.75IN 1044-82
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
5349485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
COLLAR EXTRICAT BABY NO NECK 980100
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
2963879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
COLLAR EXTRICAT BABY NO NECK 980100
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
2963879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$101.71
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$101.71
|
| Rate for Payer: The Alliance Commercial |
$84.76
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Collect Blood-Catheter Rad Onc
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4494656
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.28 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$181.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$139.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.28
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| 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 |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| 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 |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| 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 |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$181.84
|
| 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 |
$209.82
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
Collect Blood-Catheter Rad Onc
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4494656
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| Rate for Payer: Health EOS Commercial |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$167.86
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
Collect Blood-Port Rad Onc
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
4494655
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.35
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| 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 |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| 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 |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| 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 |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| 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 |
$144.30
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Collect Blood-Port Rad Onc
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
4494655
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
COLLECTION: Venous Draw
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3029072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
COLLECTION: Venous Draw
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3029072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$38.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare PPO |
$35.10
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: Wellcare Medicare |
$9.71
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
