|
Coxsackie B (1-6) Antibodies, Serum
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$54.20 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.49
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.33
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$54.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare PPO |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Coxsackie B (1-6) Antibodies, Serum
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$59.63 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.33
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$53.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$59.63
|
|
|
Coxsackie B (1-6) Antibodies, Serum
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Cpap Inline Nebkit
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
3040340
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Cpap Inline Nebkit
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
3040340
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
CPAP Titration
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103327
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,462.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$5,183.57
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,981.04
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
CPAP Titration
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103327
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,907.61 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$4,784.83
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
C-Peptide
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
C-Peptide
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$151.01
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
C-Peptide
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
C PLATE HALLU LOCK SZ 0 RT 290335SND
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.12 |
| Max. Negotiated Rate |
$7,619.96 |
| Rate for Payer: Aetna Commercial |
$7,454.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,123.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,319.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,383.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,141.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,975.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,389.76
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,619.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,635.05
|
| Rate for Payer: Health EOS Commercial |
$7,371.48
|
| Rate for Payer: HFN Commercial |
$7,619.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,211.92
|
| Rate for Payer: Multiplan Commercial |
$6,626.05
|
| Rate for Payer: NAPHCARE Commercial |
$4,969.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,619.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,058.45
|
| Rate for Payer: Quartz Commercial |
$5,383.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4,969.54
|
| Rate for Payer: The Alliance Commercial |
$4,141.28
|
| Rate for Payer: WEA Trust Commercial |
$4,555.41
|
| Rate for Payer: WPS Commercial |
$6,134.67
|
|
|
C PLATE HALLU LOCK SZ 0 RT 290335SND
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,058.45 |
| Max. Negotiated Rate |
$7,619.96 |
| Rate for Payer: Aetna Commercial |
$7,454.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,123.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,389.76
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,619.96
|
| Rate for Payer: Health EOS Commercial |
$7,371.48
|
| Rate for Payer: HFN Commercial |
$7,619.96
|
| Rate for Payer: Multiplan Commercial |
$6,626.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,619.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,058.45
|
| Rate for Payer: Quartz Commercial |
$4,969.54
|
| Rate for Payer: WEA Trust Commercial |
$4,555.41
|
| Rate for Payer: WPS Commercial |
$6,134.67
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Professional
|
Both
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$311.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.56
|
| Rate for Payer: Health EOS Commercial |
$298.12
|
| Rate for Payer: HFN Commercial |
$311.22
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$311.22
|
| Rate for Payer: Quartz Beloit One Network |
$144.14
|
| Rate for Payer: Quartz Commercial |
$186.73
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.70
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$196.56
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$196.56
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
CPR
|
Facility
|
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3052469
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,311.77 |
| Rate for Payer: Aetna Commercial |
$1,283.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.22
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.40
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,311.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,269.00
|
| Rate for Payer: HFN Commercial |
$1,311.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,140.67
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.77
|
| Rate for Payer: Quartz Beloit One Network |
$698.66
|
| Rate for Payer: Quartz Commercial |
$926.80
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: WEA Trust Commercial |
$784.21
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,056.08
|
|
|
CPR
|
Facility
|
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3052469
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$698.66 |
| Max. Negotiated Rate |
$1,311.77 |
| Rate for Payer: Aetna Commercial |
$1,283.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.70
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,311.77
|
| Rate for Payer: Health EOS Commercial |
$1,269.00
|
| Rate for Payer: HFN Commercial |
$1,311.77
|
| Rate for Payer: Multiplan Commercial |
$1,140.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.77
|
| Rate for Payer: Quartz Beloit One Network |
$698.66
|
| Rate for Payer: Quartz Commercial |
$855.50
|
| Rate for Payer: WEA Trust Commercial |
$784.21
|
| Rate for Payer: WPS Commercial |
$1,056.08
|
|
|
CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS 20985
|
Professional
|
Both
|
$1,810.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
6250435
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.44 |
| Max. Negotiated Rate |
$1,788.28 |
| Rate for Payer: Aetna Commercial |
$1,788.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.86
|
| Rate for Payer: Aetna Managed Medicare |
$115.73
|
| Rate for Payer: Anthem Medicare Advantage |
$115.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.73
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.73
|
| Rate for Payer: Health EOS Commercial |
$1,712.98
|
| Rate for Payer: HFN Commercial |
$1,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$492.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.73
|
| Rate for Payer: Multiplan Commercial |
$1,505.92
|
| Rate for Payer: NAPHCARE Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,788.28
|
| Rate for Payer: Quartz Beloit One Network |
$828.26
|
| Rate for Payer: Quartz Commercial |
$1,072.97
|
| Rate for Payer: Quartz Medicare Advantage |
$115.73
|
| Rate for Payer: The Alliance Commercial |
$491.86
|
| Rate for Payer: United Healthcare Medicaid |
$108.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.73
|
| Rate for Payer: WEA Trust Commercial |
$1,035.32
|
| Rate for Payer: WPS Commercial |
$520.79
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$42,166.80
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$12,792.82 |
| Max. Negotiated Rate |
$42,166.80 |
| Rate for Payer: Aetna Managed Medicare |
$12,792.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,004.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,830.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,490.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12,792.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,792.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,792.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,792.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,297.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,792.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,683.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,792.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,792.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,792.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,792.82
|
| Rate for Payer: NAPHCARE Commercial |
$19,189.23
|
| Rate for Payer: Quartz Medicare Advantage |
$12,792.82
|
| Rate for Payer: The Alliance Commercial |
$42,166.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,792.82
|
| Rate for Payer: United Healthcare PPO |
$23,887.60
|
| Rate for Payer: Wellcare Medicare |
$12,792.82
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$28,707.12
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$8,400.85 |
| Max. Negotiated Rate |
$28,707.12 |
| Rate for Payer: Aetna Managed Medicare |
$8,400.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,491.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,239.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,378.50
|
| Rate for Payer: Anthem Medicare Advantage |
$8,400.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,400.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,400.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,400.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,181.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,400.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,811.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,400.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,400.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,400.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,400.85
|
| Rate for Payer: NAPHCARE Commercial |
$12,601.27
|
| Rate for Payer: Quartz Medicare Advantage |
$8,400.85
|
| Rate for Payer: The Alliance Commercial |
$28,707.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,400.85
|
| Rate for Payer: United Healthcare PPO |
$16,201.89
|
| Rate for Payer: Wellcare Medicare |
$8,400.85
|
|
|
CRANIAL AND SPINAL SHUNT PROCEDURES
|
Facility
|
OP
|
$1,215.37
|
|
|
Service Code
|
EAPG 00268
|
| Min. Negotiated Rate |
$1,168.62 |
| Max. Negotiated Rate |
$1,215.37 |
| Rate for Payer: Anthem Medicaid |
$1,168.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,168.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,168.62
|
| Rate for Payer: Dean Health Medicaid |
$1,168.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,168.62
|
| Rate for Payer: Managed Health Services Medicaid |
$1,215.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,168.62
|
| Rate for Payer: United Healthcare Medicaid |
$1,168.62
|
|
|
CRANIOFACIAL RECONSTRUCTION
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959954
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
CRANIOFACIAL RECONSTRUCTION
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959954
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$81,984.24
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$24,317.63 |
| Max. Negotiated Rate |
$81,984.24 |
| Rate for Payer: Aetna Managed Medicare |
$24,317.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,840.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,999.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,402.45
|
| Rate for Payer: Anthem Medicare Advantage |
$24,317.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,317.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,317.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,317.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,841.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,317.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,888.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,317.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,317.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,317.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,317.63
|
| Rate for Payer: NAPHCARE Commercial |
$36,476.45
|
| Rate for Payer: Quartz Medicare Advantage |
$24,317.63
|
| Rate for Payer: The Alliance Commercial |
$81,984.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,317.63
|
| Rate for Payer: United Healthcare PPO |
$46,624.25
|
| Rate for Payer: Wellcare Medicare |
$24,317.63
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$122,432.96
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$35,326.30 |
| Max. Negotiated Rate |
$122,432.96 |
| Rate for Payer: Aetna Managed Medicare |
$35,326.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99,205.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,040.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72,243.06
|
| Rate for Payer: Anthem Medicare Advantage |
$35,326.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,326.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,326.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,326.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80,196.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,326.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89,556.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,326.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,326.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,326.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,326.30
|
| Rate for Payer: NAPHCARE Commercial |
$52,989.46
|
| Rate for Payer: Quartz Medicare Advantage |
$35,326.30
|
| Rate for Payer: The Alliance Commercial |
$122,432.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,326.30
|
| Rate for Payer: United Healthcare PPO |
$69,720.87
|
| Rate for Payer: Wellcare Medicare |
$35,326.30
|
|
