|
Crutches dispensed - Adult tall - Treatments Done
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
3228181
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Crutches dispensed - Adult tall - Treatments Done
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
3228181
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Crutches dispensed - Youth - Treatments Done
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
3228180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Crutches dispensed - Youth - Treatments Done
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
3228180
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
CRUTCHES YOUTH LATEX FREE MDSV80536
|
Facility
|
IP
|
$280.00
|
|
| Hospital Charge Code |
2969059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
CRUTCHES YOUTH LATEX FREE MDSV80536
|
Facility
|
OP
|
$280.00
|
|
| Hospital Charge Code |
2969059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Aetna Managed Medicare |
$81.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.96
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$189.28
|
| Rate for Payer: Quartz Medicare Advantage |
$174.72
|
| Rate for Payer: The Alliance Commercial |
$145.60
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
CRYOABLATION OF PROSTATE
|
Facility
|
OP
|
$20,534.00
|
|
| Hospital Charge Code |
5374701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,979.50 |
| Max. Negotiated Rate |
$19,646.93 |
| Rate for Payer: Aetna Commercial |
$19,219.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,365.61
|
| Rate for Payer: Aetna Managed Medicare |
$5,979.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,880.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,677.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,250.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,318.34
|
| Rate for Payer: Cash Price |
$6,160.20
|
| Rate for Payer: Cigna Commercial |
$19,646.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,950.79
|
| Rate for Payer: Health EOS Commercial |
$19,006.27
|
| Rate for Payer: HFN Commercial |
$19,646.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,016.52
|
| Rate for Payer: Multiplan Commercial |
$17,084.29
|
| Rate for Payer: NAPHCARE Commercial |
$12,813.22
|
| Rate for Payer: Preferred Network Access Commercial |
$19,646.93
|
| Rate for Payer: Quartz Beloit One Network |
$10,464.13
|
| Rate for Payer: Quartz Commercial |
$13,880.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12,813.22
|
| Rate for Payer: The Alliance Commercial |
$10,677.68
|
| Rate for Payer: WEA Trust Commercial |
$11,745.45
|
| Rate for Payer: WPS Commercial |
$15,817.34
|
|
|
CRYOABLATION OF PROSTATE
|
Facility
|
IP
|
$20,534.00
|
|
| Hospital Charge Code |
5374701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,464.13 |
| Max. Negotiated Rate |
$19,646.93 |
| Rate for Payer: Aetna Commercial |
$19,219.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,365.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,318.34
|
| Rate for Payer: Cash Price |
$6,160.20
|
| Rate for Payer: Cigna Commercial |
$19,646.93
|
| Rate for Payer: Health EOS Commercial |
$19,006.27
|
| Rate for Payer: HFN Commercial |
$19,646.93
|
| Rate for Payer: Multiplan Commercial |
$17,084.29
|
| Rate for Payer: Preferred Network Access Commercial |
$19,646.93
|
| Rate for Payer: Quartz Beloit One Network |
$10,464.13
|
| Rate for Payer: Quartz Commercial |
$12,813.22
|
| Rate for Payer: WEA Trust Commercial |
$11,745.45
|
| Rate for Payer: WPS Commercial |
$15,817.34
|
|
|
CRYOABLATION OF RENALS
|
Facility
|
OP
|
$19,322.00
|
|
| Hospital Charge Code |
5374694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,626.57 |
| Max. Negotiated Rate |
$18,487.29 |
| Rate for Payer: Aetna Commercial |
$18,085.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,281.60
|
| Rate for Payer: Aetna Managed Medicare |
$5,626.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,061.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,047.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,645.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,650.29
|
| Rate for Payer: Cash Price |
$5,796.60
|
| Rate for Payer: Cigna Commercial |
$18,487.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,245.40
|
| Rate for Payer: Health EOS Commercial |
$17,884.44
|
| Rate for Payer: HFN Commercial |
$18,487.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,071.16
|
| Rate for Payer: Multiplan Commercial |
$16,075.90
|
| Rate for Payer: NAPHCARE Commercial |
$12,056.93
|
| Rate for Payer: Preferred Network Access Commercial |
$18,487.29
|
| Rate for Payer: Quartz Beloit One Network |
$9,846.49
|
| Rate for Payer: Quartz Commercial |
$13,061.67
|
| Rate for Payer: Quartz Medicare Advantage |
$12,056.93
|
| Rate for Payer: The Alliance Commercial |
$10,047.44
|
| Rate for Payer: WEA Trust Commercial |
$11,052.18
|
| Rate for Payer: WPS Commercial |
$14,883.74
|
|
|
CRYOABLATION OF RENALS
|
Facility
|
IP
|
$19,322.00
|
|
| Hospital Charge Code |
5374694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,846.49 |
| Max. Negotiated Rate |
$18,487.29 |
| Rate for Payer: Aetna Commercial |
$18,085.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,281.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,650.29
|
| Rate for Payer: Cash Price |
$5,796.60
|
| Rate for Payer: Cigna Commercial |
$18,487.29
|
| Rate for Payer: Health EOS Commercial |
$17,884.44
|
| Rate for Payer: HFN Commercial |
$18,487.29
|
| Rate for Payer: Multiplan Commercial |
$16,075.90
|
| Rate for Payer: Preferred Network Access Commercial |
$18,487.29
|
| Rate for Payer: Quartz Beloit One Network |
$9,846.49
|
| Rate for Payer: Quartz Commercial |
$12,056.93
|
| Rate for Payer: WEA Trust Commercial |
$11,052.18
|
| Rate for Payer: WPS Commercial |
$14,883.74
|
|
|
CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,383.00
|
|
| Hospital Charge Code |
5374693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,271.98 |
| Max. Negotiated Rate |
$8,020.85 |
| Rate for Payer: Aetna Commercial |
$7,846.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,497.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,620.71
|
| Rate for Payer: Cash Price |
$2,514.90
|
| Rate for Payer: Cigna Commercial |
$8,020.85
|
| Rate for Payer: Health EOS Commercial |
$7,759.30
|
| Rate for Payer: HFN Commercial |
$8,020.85
|
| Rate for Payer: Multiplan Commercial |
$6,974.66
|
| Rate for Payer: Preferred Network Access Commercial |
$8,020.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,271.98
|
| Rate for Payer: Quartz Commercial |
$5,230.99
|
| Rate for Payer: WEA Trust Commercial |
$4,795.08
|
| Rate for Payer: WPS Commercial |
$6,457.42
|
|
|
CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,383.00
|
|
| Hospital Charge Code |
5374693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,441.13 |
| Max. Negotiated Rate |
$8,020.85 |
| Rate for Payer: Aetna Commercial |
$7,846.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,497.76
|
| Rate for Payer: Aetna Managed Medicare |
$2,441.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,666.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,359.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,184.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,620.71
|
| Rate for Payer: Cash Price |
$2,514.90
|
| Rate for Payer: Cigna Commercial |
$8,020.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,878.91
|
| Rate for Payer: Health EOS Commercial |
$7,759.30
|
| Rate for Payer: HFN Commercial |
$8,020.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,538.74
|
| Rate for Payer: Multiplan Commercial |
$6,974.66
|
| Rate for Payer: NAPHCARE Commercial |
$5,230.99
|
| Rate for Payer: Preferred Network Access Commercial |
$8,020.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,271.98
|
| Rate for Payer: Quartz Commercial |
$5,666.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5,230.99
|
| Rate for Payer: The Alliance Commercial |
$4,359.16
|
| Rate for Payer: WEA Trust Commercial |
$4,795.08
|
| Rate for Payer: WPS Commercial |
$6,457.42
|
|
|
Cryo AHF
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052832
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$138.53
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
Cryo AHF
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052832
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$296.44 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$74.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.82
|
| Rate for Payer: Anthem Medicare Advantage |
$74.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.11
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$74.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$74.11
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$74.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$74.11
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$111.17
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$150.07
|
| Rate for Payer: Quartz Medicare Advantage |
$74.11
|
| Rate for Payer: The Alliance Commercial |
$296.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.11
|
| Rate for Payer: United Healthcare PPO |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: Wellcare Medicare |
$74.11
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
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 |
$71.32 |
| Max. Negotiated Rate |
$567.96 |
| Rate for Payer: Aetna Commercial |
$437.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage |
$126.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.21
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$437.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.21
|
| Rate for Payer: Health EOS Commercial |
$419.26
|
| Rate for Payer: HFN Commercial |
$437.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$504.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.21
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$189.32
|
| Rate for Payer: Preferred Network Access Commercial |
$437.68
|
| Rate for Payer: Quartz Beloit One Network |
$202.72
|
| Rate for Payer: Quartz Commercial |
$262.61
|
| Rate for Payer: Quartz Medicare Advantage |
$126.21
|
| Rate for Payer: The Alliance Commercial |
$536.41
|
| Rate for Payer: United Healthcare Medicaid |
$71.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.21
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$567.96
|
|
|
CRYO CUFF KNEE LARGE
|
Facility
|
IP
|
$1,398.00
|
|
| Hospital Charge Code |
2964099
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$712.42 |
| Max. Negotiated Rate |
$1,337.61 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$872.35
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
CRYO CUFF KNEE LARGE
|
Facility
|
OP
|
$1,398.00
|
|
| Hospital Charge Code |
2964099
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.10 |
| Max. Negotiated Rate |
$1,337.61 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Aetna Managed Medicare |
$407.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.64
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.44
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: NAPHCARE Commercial |
$872.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$945.05
|
| Rate for Payer: Quartz Medicare Advantage |
$872.35
|
| Rate for Payer: The Alliance Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
CRYO CUFF SHOULDER
|
Facility
|
OP
|
$1,570.00
|
|
| Hospital Charge Code |
2963334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$457.18 |
| Max. Negotiated Rate |
$1,502.18 |
| Rate for Payer: Aetna Commercial |
$1,469.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,404.21
|
| Rate for Payer: Aetna Managed Medicare |
$457.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,061.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.38
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,502.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.74
|
| Rate for Payer: Health EOS Commercial |
$1,453.19
|
| Rate for Payer: HFN Commercial |
$1,502.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.60
|
| Rate for Payer: Multiplan Commercial |
$1,306.24
|
| Rate for Payer: NAPHCARE Commercial |
$979.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,502.18
|
| Rate for Payer: Quartz Beloit One Network |
$800.07
|
| Rate for Payer: Quartz Commercial |
$1,061.32
|
| Rate for Payer: Quartz Medicare Advantage |
$979.68
|
| Rate for Payer: The Alliance Commercial |
$816.40
|
| Rate for Payer: WEA Trust Commercial |
$898.04
|
| Rate for Payer: WPS Commercial |
$1,209.37
|
|
|
CRYO CUFF SHOULDER
|
Facility
|
IP
|
$1,570.00
|
|
| Hospital Charge Code |
2963334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$800.07 |
| Max. Negotiated Rate |
$1,502.18 |
| Rate for Payer: Aetna Commercial |
$1,469.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,404.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.38
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$1,502.18
|
| Rate for Payer: Health EOS Commercial |
$1,453.19
|
| Rate for Payer: HFN Commercial |
$1,502.18
|
| Rate for Payer: Multiplan Commercial |
$1,306.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,502.18
|
| Rate for Payer: Quartz Beloit One Network |
$800.07
|
| Rate for Payer: Quartz Commercial |
$979.68
|
| Rate for Payer: WEA Trust Commercial |
$898.04
|
| Rate for Payer: WPS Commercial |
$1,209.37
|
|
|
Cryofibrinogen
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.41
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$22.06
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$58.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare PPO |
$39.78
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Cryofibrinogen
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$64.70 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$50.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$48.27
|
| Rate for Payer: HFN Commercial |
$50.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$22.06
|
| Rate for Payer: Preferred Network Access Commercial |
$50.39
|
| Rate for Payer: Quartz Beloit One Network |
$23.34
|
| Rate for Payer: Quartz Commercial |
$30.23
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$58.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$64.70
|
|
|
Cryofibrinogen
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
3579516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Cryoglobulin
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
633717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$130.42 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$130.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$124.92
|
| Rate for Payer: HFN Commercial |
$130.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$130.42
|
| Rate for Payer: Quartz Beloit One Network |
$60.40
|
| Rate for Payer: Quartz Commercial |
$78.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$29.61
|
|
|
Cryoglobulin
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
633717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Cryoglobulin
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
633717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare PPO |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: Wellcare Medicare |
$6.73
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
