|
Haptoglubin (FSURE)
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$52.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: United Healthcare PPO |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: Wellcare Medicare |
$13.08
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Haptoglubin (FSURE)
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
HARDWARE REMOVAL
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
HARDWARE REMOVAL
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
HARMONIC SCALPEL LAPAROSCOPIC TIP ACE HAR36
|
Facility
|
IP
|
$5,618.00
|
|
| Hospital Charge Code |
3321467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,862.93 |
| Max. Negotiated Rate |
$5,375.30 |
| Rate for Payer: Aetna Commercial |
$5,258.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,024.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,096.64
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,375.30
|
| Rate for Payer: Health EOS Commercial |
$5,200.02
|
| Rate for Payer: HFN Commercial |
$5,375.30
|
| Rate for Payer: Multiplan Commercial |
$4,674.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,375.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,862.93
|
| Rate for Payer: Quartz Commercial |
$3,505.63
|
| Rate for Payer: WEA Trust Commercial |
$3,213.50
|
| Rate for Payer: WPS Commercial |
$4,327.55
|
|
|
HARMONIC SCALPEL LAPAROSCOPIC TIP ACE HAR36
|
Facility
|
OP
|
$5,618.00
|
|
| Hospital Charge Code |
3321467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,635.96 |
| Max. Negotiated Rate |
$5,375.30 |
| Rate for Payer: Aetna Commercial |
$5,258.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,024.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,635.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,797.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,921.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,804.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,096.64
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,375.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,269.68
|
| Rate for Payer: Health EOS Commercial |
$5,200.02
|
| Rate for Payer: HFN Commercial |
$5,375.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,382.04
|
| Rate for Payer: Multiplan Commercial |
$4,674.18
|
| Rate for Payer: NAPHCARE Commercial |
$3,505.63
|
| Rate for Payer: Preferred Network Access Commercial |
$5,375.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,862.93
|
| Rate for Payer: Quartz Commercial |
$3,797.77
|
| Rate for Payer: Quartz Medicare Advantage |
$3,505.63
|
| Rate for Payer: The Alliance Commercial |
$2,921.36
|
| Rate for Payer: WEA Trust Commercial |
$3,213.50
|
| Rate for Payer: WPS Commercial |
$4,327.55
|
|
|
HARMONIC SHEAR FOCUS CURVED SFCS9
|
Facility
|
IP
|
$7,694.00
|
|
| Hospital Charge Code |
3072602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,920.86 |
| Max. Negotiated Rate |
$7,361.62 |
| Rate for Payer: Aetna Commercial |
$7,201.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,881.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,240.93
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,361.62
|
| Rate for Payer: Health EOS Commercial |
$7,121.57
|
| Rate for Payer: HFN Commercial |
$7,361.62
|
| Rate for Payer: Multiplan Commercial |
$6,401.41
|
| Rate for Payer: Preferred Network Access Commercial |
$7,361.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,920.86
|
| Rate for Payer: Quartz Commercial |
$4,801.06
|
| Rate for Payer: WEA Trust Commercial |
$4,400.97
|
| Rate for Payer: WPS Commercial |
$5,926.69
|
|
|
HARMONIC SHEAR FOCUS CURVED SFCS9
|
Facility
|
OP
|
$7,694.00
|
|
| Hospital Charge Code |
3072602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,240.49 |
| Max. Negotiated Rate |
$7,361.62 |
| Rate for Payer: Aetna Commercial |
$7,201.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,881.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,240.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,201.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,000.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,840.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,240.93
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,361.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,477.91
|
| Rate for Payer: Health EOS Commercial |
$7,121.57
|
| Rate for Payer: HFN Commercial |
$7,361.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,001.32
|
| Rate for Payer: Multiplan Commercial |
$6,401.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,801.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,361.62
|
| Rate for Payer: Quartz Beloit One Network |
$3,920.86
|
| Rate for Payer: Quartz Commercial |
$5,201.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4,801.06
|
| Rate for Payer: The Alliance Commercial |
$4,000.88
|
| Rate for Payer: WEA Trust Commercial |
$4,400.97
|
| Rate for Payer: WPS Commercial |
$5,926.69
|
|
|
HARTMAN'S PROCEDURE
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
HARTMAN'S PROCEDURE
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
HARVESTER OSTEOAUGER BONE GRAFT 8MM ABS-8000-08
|
Facility
|
OP
|
$4,208.00
|
|
| Hospital Charge Code |
6217011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,225.37 |
| Max. Negotiated Rate |
$4,026.21 |
| Rate for Payer: Aetna Commercial |
$3,938.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,763.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,225.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,844.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,188.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,100.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,319.45
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$4,026.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,449.06
|
| Rate for Payer: Health EOS Commercial |
$3,894.92
|
| Rate for Payer: HFN Commercial |
$4,026.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,282.24
|
| Rate for Payer: Multiplan Commercial |
$3,501.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,625.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,026.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,144.40
|
| Rate for Payer: Quartz Commercial |
$2,844.61
|
| Rate for Payer: Quartz Medicare Advantage |
$2,625.79
|
| Rate for Payer: The Alliance Commercial |
$2,188.16
|
| Rate for Payer: WEA Trust Commercial |
$2,406.98
|
| Rate for Payer: WPS Commercial |
$3,241.42
|
|
|
HARVESTER OSTEOAUGER BONE GRAFT 8MM ABS-8000-08
|
Facility
|
IP
|
$4,208.00
|
|
| Hospital Charge Code |
6217011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$4,026.21 |
| Rate for Payer: Aetna Commercial |
$3,938.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,763.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,319.45
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$4,026.21
|
| Rate for Payer: Health EOS Commercial |
$3,894.92
|
| Rate for Payer: HFN Commercial |
$4,026.21
|
| Rate for Payer: Multiplan Commercial |
$3,501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,026.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,144.40
|
| Rate for Payer: Quartz Commercial |
$2,625.79
|
| Rate for Payer: WEA Trust Commercial |
$2,406.98
|
| Rate for Payer: WPS Commercial |
$3,241.42
|
|
|
HARVESTER QUADPRO 10MM AR-2386-10
|
Facility
|
IP
|
$4,663.00
|
|
| Hospital Charge Code |
5831661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.26 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$2,909.71
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
HARVESTER QUADPRO 10MM AR-2386-10
|
Facility
|
OP
|
$4,663.00
|
|
| Hospital Charge Code |
5831661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.87 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,357.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,152.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,424.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,327.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,713.87
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,637.14
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,909.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$3,152.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,909.71
|
| Rate for Payer: The Alliance Commercial |
$2,424.76
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
HARVESTER QUADPRO 9MM AR-2386-09
|
Facility
|
OP
|
$4,663.00
|
|
| Hospital Charge Code |
5861688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.87 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,357.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,152.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,424.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,327.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,713.87
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,637.14
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,909.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$3,152.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,909.71
|
| Rate for Payer: The Alliance Commercial |
$2,424.76
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
HARVESTER QUADPRO 9MM AR-2386-09
|
Facility
|
IP
|
$4,663.00
|
|
| Hospital Charge Code |
5861688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.26 |
| Max. Negotiated Rate |
$4,461.56 |
| Rate for Payer: Aetna Commercial |
$4,364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,170.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,570.25
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,461.56
|
| Rate for Payer: Health EOS Commercial |
$4,316.07
|
| Rate for Payer: HFN Commercial |
$4,461.56
|
| Rate for Payer: Multiplan Commercial |
$3,879.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,461.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,376.26
|
| Rate for Payer: Quartz Commercial |
$2,909.71
|
| Rate for Payer: WEA Trust Commercial |
$2,667.24
|
| Rate for Payer: WPS Commercial |
$3,591.91
|
|
|
HARVESTING SYSTEM FASTGRAFTER (7MM FASTGRAFTER & PUSHER INSTRUMENT) SK27
|
Facility
|
IP
|
$7,087.00
|
|
| Hospital Charge Code |
6175180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,611.54 |
| Max. Negotiated Rate |
$6,780.84 |
| Rate for Payer: Aetna Commercial |
$6,633.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,338.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,906.35
|
| Rate for Payer: Cash Price |
$2,126.10
|
| Rate for Payer: Cigna Commercial |
$6,780.84
|
| Rate for Payer: Health EOS Commercial |
$6,559.73
|
| Rate for Payer: HFN Commercial |
$6,780.84
|
| Rate for Payer: Multiplan Commercial |
$5,896.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,780.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,611.54
|
| Rate for Payer: Quartz Commercial |
$4,422.29
|
| Rate for Payer: WEA Trust Commercial |
$4,053.76
|
| Rate for Payer: WPS Commercial |
$5,459.12
|
|
|
HARVESTING SYSTEM FASTGRAFTER (7MM FASTGRAFTER & PUSHER INSTRUMENT) SK27
|
Facility
|
OP
|
$7,087.00
|
|
| Hospital Charge Code |
6175180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,063.73 |
| Max. Negotiated Rate |
$6,780.84 |
| Rate for Payer: Aetna Commercial |
$6,633.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,338.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,063.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,790.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,685.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,537.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,906.35
|
| Rate for Payer: Cash Price |
$2,126.10
|
| Rate for Payer: Cigna Commercial |
$6,780.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,124.63
|
| Rate for Payer: Health EOS Commercial |
$6,559.73
|
| Rate for Payer: HFN Commercial |
$6,780.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,527.86
|
| Rate for Payer: Multiplan Commercial |
$5,896.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,422.29
|
| Rate for Payer: Preferred Network Access Commercial |
$6,780.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,611.54
|
| Rate for Payer: Quartz Commercial |
$4,790.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,422.29
|
| Rate for Payer: The Alliance Commercial |
$3,685.24
|
| Rate for Payer: WEA Trust Commercial |
$4,053.76
|
| Rate for Payer: WPS Commercial |
$5,459.12
|
|
|
HAWKIN II W/HARDWIRE 20gX10cm #242100
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2973461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
HAWKIN II W/HARDWIRE 20gX10cm #242100
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2973461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.92
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.96
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$425.57
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$425.57
|
| Rate for Payer: The Alliance Commercial |
$354.64
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
Hb Variant Mass Spec
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Aetna Commercial |
$665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.62
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$680.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$658.10
|
| Rate for Payer: HFN Commercial |
$680.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$680.28
|
| Rate for Payer: Quartz Beloit One Network |
$362.33
|
| Rate for Payer: Quartz Commercial |
$480.64
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: United Healthcare PPO |
$554.58
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: Wellcare Medicare |
$25.07
|
| Rate for Payer: WPS Commercial |
$547.68
|
|
|
Hb Variant Mass Spec
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$702.47 |
| Rate for Payer: Aetna Commercial |
$702.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$702.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$672.89
|
| Rate for Payer: HFN Commercial |
$702.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$702.47
|
| Rate for Payer: Quartz Beloit One Network |
$325.35
|
| Rate for Payer: Quartz Commercial |
$421.48
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$99.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$110.33
|
|
|
Hb Variant Mass Spec
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$362.33 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Aetna Commercial |
$665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.90
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$680.28
|
| Rate for Payer: Health EOS Commercial |
$658.10
|
| Rate for Payer: HFN Commercial |
$680.28
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: Preferred Network Access Commercial |
$680.28
|
| Rate for Payer: Quartz Beloit One Network |
$362.33
|
| Rate for Payer: Quartz Commercial |
$443.66
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$547.68
|
|
|
HCG, Serum
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2942984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
HCG, Serum
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2942984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$151.16 |
| Rate for Payer: Aetna Commercial |
$151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$151.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$144.80
|
| Rate for Payer: HFN Commercial |
$151.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$151.16
|
| Rate for Payer: Quartz Beloit One Network |
$70.01
|
| Rate for Payer: Quartz Commercial |
$90.70
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$61.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
