|
Crutches dispensed - Youth - Treatments Done
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
3228180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$1,160.00 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$188.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$174.00
|
| Rate for Payer: The Alliance Commercial |
$1,160.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Crutches dispensed - Youth - Treatments Done
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
3228180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
CRUTCHES YOUTH LATEX FREE MDSV80536
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
2969059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Aetna Managed Medicare |
$78.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.69
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$182.00
|
| Rate for Payer: Quartz Medicare Advantage |
$168.00
|
| Rate for Payer: The Alliance Commercial |
$1,120.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
CRUTCHES YOUTH LATEX FREE MDSV80536
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
2969059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
CRYOABLATION OF PROSTATE
|
Facility
|
OP
|
$20,534.00
|
|
| Hospital Charge Code |
5374701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,749.52 |
| Max. Negotiated Rate |
$82,136.00 |
| Rate for Payer: Aetna Commercial |
$18,480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,659.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,749.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,347.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,267.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,856.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,883.02
|
| Rate for Payer: Cash Price |
$6,160.20
|
| Rate for Payer: Cigna Commercial |
$18,891.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,490.83
|
| Rate for Payer: Health EOS Commercial |
$18,275.26
|
| Rate for Payer: HFN Commercial |
$18,891.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,400.50
|
| Rate for Payer: Multiplan Commercial |
$16,427.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,891.28
|
| Rate for Payer: Quartz Beloit One Network |
$10,061.66
|
| Rate for Payer: Quartz Commercial |
$13,347.10
|
| Rate for Payer: Quartz Medicare Advantage |
$12,320.40
|
| Rate for Payer: The Alliance Commercial |
$82,136.00
|
| Rate for Payer: WEA Trust Commercial |
$11,293.70
|
| Rate for Payer: WPS Commercial |
$15,209.53
|
|
|
CRYOABLATION OF PROSTATE
|
Facility
|
IP
|
$20,534.00
|
|
| Hospital Charge Code |
5374701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,061.66 |
| Max. Negotiated Rate |
$18,891.28 |
| Rate for Payer: Aetna Commercial |
$18,480.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,659.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,883.02
|
| Rate for Payer: Cash Price |
$6,160.20
|
| Rate for Payer: Cigna Commercial |
$18,891.28
|
| Rate for Payer: Health EOS Commercial |
$18,275.26
|
| Rate for Payer: HFN Commercial |
$18,891.28
|
| Rate for Payer: Multiplan Commercial |
$16,427.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,320.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,891.28
|
| Rate for Payer: Quartz Beloit One Network |
$10,061.66
|
| Rate for Payer: Quartz Commercial |
$12,320.40
|
| Rate for Payer: WEA Trust Commercial |
$11,293.70
|
| Rate for Payer: WPS Commercial |
$15,209.53
|
|
|
CRYOABLATION OF RENALS
|
Facility
|
OP
|
$19,322.00
|
|
| Hospital Charge Code |
5374694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,410.16 |
| Max. Negotiated Rate |
$77,288.00 |
| Rate for Payer: Aetna Commercial |
$17,389.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,616.92
|
| Rate for Payer: Aetna Managed Medicare |
$5,410.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,559.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,274.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,240.66
|
| Rate for Payer: Cash Price |
$5,796.60
|
| Rate for Payer: Cigna Commercial |
$17,776.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,812.59
|
| Rate for Payer: Health EOS Commercial |
$17,196.58
|
| Rate for Payer: HFN Commercial |
$17,776.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,491.50
|
| Rate for Payer: Multiplan Commercial |
$15,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,593.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,776.24
|
| Rate for Payer: Quartz Beloit One Network |
$9,467.78
|
| Rate for Payer: Quartz Commercial |
$12,559.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11,593.20
|
| Rate for Payer: The Alliance Commercial |
$77,288.00
|
| Rate for Payer: WEA Trust Commercial |
$10,627.10
|
| Rate for Payer: WPS Commercial |
$14,311.81
|
|
|
CRYOABLATION OF RENALS
|
Facility
|
IP
|
$19,322.00
|
|
| Hospital Charge Code |
5374694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,467.78 |
| Max. Negotiated Rate |
$17,776.24 |
| Rate for Payer: Aetna Commercial |
$17,389.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,616.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,240.66
|
| Rate for Payer: Cash Price |
$5,796.60
|
| Rate for Payer: Cigna Commercial |
$17,776.24
|
| Rate for Payer: Health EOS Commercial |
$17,196.58
|
| Rate for Payer: HFN Commercial |
$17,776.24
|
| Rate for Payer: Multiplan Commercial |
$15,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,593.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17,776.24
|
| Rate for Payer: Quartz Beloit One Network |
$9,467.78
|
| Rate for Payer: Quartz Commercial |
$11,593.20
|
| Rate for Payer: WEA Trust Commercial |
$10,627.10
|
| Rate for Payer: WPS Commercial |
$14,311.81
|
|
|
CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,383.00
|
|
| Hospital Charge Code |
5374693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,347.24 |
| Max. Negotiated Rate |
$33,532.00 |
| Rate for Payer: Aetna Commercial |
$7,544.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,209.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,347.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,448.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,023.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,442.99
|
| Rate for Payer: Cash Price |
$2,514.90
|
| Rate for Payer: Cigna Commercial |
$7,712.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,691.13
|
| Rate for Payer: Health EOS Commercial |
$7,460.87
|
| Rate for Payer: HFN Commercial |
$7,712.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,287.25
|
| Rate for Payer: Multiplan Commercial |
$6,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,029.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,712.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,107.67
|
| Rate for Payer: Quartz Commercial |
$5,448.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,029.80
|
| Rate for Payer: The Alliance Commercial |
$33,532.00
|
| Rate for Payer: WEA Trust Commercial |
$4,610.65
|
| Rate for Payer: WPS Commercial |
$6,209.29
|
|
|
CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,383.00
|
|
| Hospital Charge Code |
5374693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,107.67 |
| Max. Negotiated Rate |
$7,712.36 |
| Rate for Payer: Aetna Commercial |
$7,544.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,209.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,442.99
|
| Rate for Payer: Cash Price |
$2,514.90
|
| Rate for Payer: Cigna Commercial |
$7,712.36
|
| Rate for Payer: Health EOS Commercial |
$7,460.87
|
| Rate for Payer: HFN Commercial |
$7,712.36
|
| Rate for Payer: Multiplan Commercial |
$6,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,029.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,712.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,107.67
|
| Rate for Payer: Quartz Commercial |
$5,029.80
|
| Rate for Payer: WEA Trust Commercial |
$4,610.65
|
| Rate for Payer: WPS Commercial |
$6,209.29
|
|
|
Cryo AHF
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052832
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$248.44 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| Rate for Payer: Aetna Managed Medicare |
$62.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.56
|
| Rate for Payer: Anthem Medicare Advantage |
$62.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.11
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.11
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.11
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$93.16
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$144.30
|
| Rate for Payer: Quartz Medicare Advantage |
$62.11
|
| Rate for Payer: The Alliance Commercial |
$248.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.11
|
| Rate for Payer: United Healthcare PPO |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: Wellcare Medicare |
$62.11
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
Cryo AHF
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052832
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$204.24 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$133.20
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$133.20
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
Cryocautery Of Cervix, Initial Or Repeat
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
1188882
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.58 |
| Max. Negotiated Rate |
$484.70 |
| Rate for Payer: Aetna Commercial |
$420.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.80
|
| Rate for Payer: Health EOS Commercial |
$403.13
|
| Rate for Payer: HFN Commercial |
$420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$484.70
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Preferred Network Access Commercial |
$420.85
|
| Rate for Payer: Quartz Beloit One Network |
$194.92
|
| Rate for Payer: Quartz Commercial |
$252.51
|
| Rate for Payer: The Alliance Commercial |
$221.50
|
| Rate for Payer: United Healthcare Medicaid |
$68.58
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
CRYO CUFF KNEE LARGE
|
Facility
|
IP
|
$1,398.00
|
|
| Hospital Charge Code |
2964099
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$685.02 |
| Max. Negotiated Rate |
$1,286.16 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$838.80
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
CRYO CUFF KNEE LARGE
|
Facility
|
OP
|
$1,398.00
|
|
| Hospital Charge Code |
2964099
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$391.44 |
| Max. Negotiated Rate |
$5,592.00 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Aetna Managed Medicare |
$391.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$782.32
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,048.50
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$908.70
|
| Rate for Payer: Quartz Medicare Advantage |
$838.80
|
| Rate for Payer: The Alliance Commercial |
$5,592.00
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
CRYO CUFF SHOULDER
|
Facility
|
IP
|
$1,570.00
|
|
| Hospital Charge Code |
2963334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$769.30 |
| Max. Negotiated Rate |
$1,444.40 |
| Rate for Payer: Aetna Commercial |
$1,413.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.10
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,444.40
|
| Rate for Payer: Health EOS Commercial |
$1,397.30
|
| Rate for Payer: HFN Commercial |
$1,444.40
|
| Rate for Payer: Multiplan Commercial |
$1,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$942.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.40
|
| Rate for Payer: Quartz Beloit One Network |
$769.30
|
| Rate for Payer: Quartz Commercial |
$942.00
|
| Rate for Payer: WEA Trust Commercial |
$863.50
|
| Rate for Payer: WPS Commercial |
$1,162.90
|
|
|
CRYO CUFF SHOULDER
|
Facility
|
OP
|
$1,570.00
|
|
| Hospital Charge Code |
2963334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$6,280.00 |
| Rate for Payer: Aetna Commercial |
$1,413.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.20
|
| Rate for Payer: Aetna Managed Medicare |
$439.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,020.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$753.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.10
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,444.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$878.57
|
| Rate for Payer: Health EOS Commercial |
$1,397.30
|
| Rate for Payer: HFN Commercial |
$1,444.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.50
|
| Rate for Payer: Multiplan Commercial |
$1,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$942.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.40
|
| Rate for Payer: Quartz Beloit One Network |
$769.30
|
| Rate for Payer: Quartz Commercial |
$1,020.50
|
| Rate for Payer: Quartz Medicare Advantage |
$942.00
|
| Rate for Payer: The Alliance Commercial |
$6,280.00
|
| Rate for Payer: WEA Trust Commercial |
$863.50
|
| Rate for Payer: WPS Commercial |
$1,162.90
|
|
|
Cryofibrinogen
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$56.56 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$14.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.47
|
| Rate for Payer: Anthem Medicaid |
$9.02
|
| Rate for Payer: Anthem Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.14
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.54
|
| Rate for Payer: Dean Health Medicaid |
$9.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.14
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.14
|
| Rate for Payer: Managed Health Services Medicaid |
$9.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.21
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.02
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.14
|
| Rate for Payer: The Alliance Commercial |
$56.56
|
| Rate for Payer: United Healthcare Medicaid |
$9.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare PPO |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: Wellcare Medicare |
$14.14
|
| Rate for Payer: WMAP Medicaid |
$9.02
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Cryofibrinogen
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Cryofibrinogen
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$49.91 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.60
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: HFN Commercial |
$48.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.91
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Cryoglobulin
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
633717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.74
|
| Rate for Payer: Anthem Medicaid |
$6.69
|
| Rate for Payer: Anthem Medicare Advantage |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.47
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Dean Health Medicaid |
$6.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.47
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.47
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.70
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.69
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.47
|
| Rate for Payer: The Alliance Commercial |
$25.88
|
| Rate for Payer: United Healthcare Medicaid |
$6.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare PPO |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: WMAP Medicaid |
$6.69
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Cryoglobulin
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
633717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Cryoglobulin
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3595600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Cryoglobulin
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3595600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.00
|
| Rate for Payer: Health EOS Commercial |
$22.75
|
| Rate for Payer: HFN Commercial |
$23.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.75
|
| Rate for Payer: Quartz Beloit One Network |
$11.00
|
| Rate for Payer: Quartz Commercial |
$14.25
|
| Rate for Payer: The Alliance Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Cryoglobulin
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3595600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.74
|
| Rate for Payer: Anthem Medicaid |
$6.69
|
| Rate for Payer: Anthem Medicare Advantage |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.47
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Dean Health Medicaid |
$6.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.47
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.47
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$9.70
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.69
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6.47
|
| Rate for Payer: The Alliance Commercial |
$25.88
|
| Rate for Payer: United Healthcare Medicaid |
$6.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare PPO |
$18.75
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: WMAP Medicaid |
$6.69
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
