|
HANDPIECE MINERVA STERILE DISPOSABLE MIN9770
|
Facility
|
IP
|
$6,031.00
|
|
| Hospital Charge Code |
5415056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,955.19 |
| Max. Negotiated Rate |
$5,548.52 |
| Rate for Payer: Aetna Commercial |
$5,427.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,186.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,196.43
|
| Rate for Payer: Cash Price |
$1,809.30
|
| Rate for Payer: Cigna Commercial |
$5,548.52
|
| Rate for Payer: Health EOS Commercial |
$5,367.59
|
| Rate for Payer: HFN Commercial |
$5,548.52
|
| Rate for Payer: Multiplan Commercial |
$4,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,548.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.19
|
| Rate for Payer: Quartz Commercial |
$3,618.60
|
| Rate for Payer: WEA Trust Commercial |
$3,317.05
|
| Rate for Payer: WPS Commercial |
$4,467.16
|
|
|
HAND PIECE OMNIGUIDE GYNE-LAP CURVED 10191
|
Facility
|
IP
|
$814.00
|
|
| Hospital Charge Code |
5563642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.86 |
| Max. Negotiated Rate |
$748.88 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$488.40
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
HAND PIECE OMNIGUIDE GYNE-LAP CURVED 10191
|
Facility
|
OP
|
$814.00
|
|
| Hospital Charge Code |
5563642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Aetna Managed Medicare |
$227.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.51
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.50
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$529.10
|
| Rate for Payer: Quartz Medicare Advantage |
$488.40
|
| Rate for Payer: The Alliance Commercial |
$3,256.00
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
HANDPIECE THUNDERBEAT 5MM X 35CM FRONT-ACTUATED GRIP TB-0535FC
|
Facility
|
IP
|
$7,777.00
|
|
| Hospital Charge Code |
4595661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,810.73 |
| Max. Negotiated Rate |
$7,154.84 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$4,666.20
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
HANDPIECE THUNDERBEAT 5MM X 35CM FRONT-ACTUATED GRIP TB-0535FC
|
Facility
|
OP
|
$7,777.00
|
|
| Hospital Charge Code |
4595661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,177.56 |
| Max. Negotiated Rate |
$31,108.00 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,055.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,888.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,732.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.01
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,832.75
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$5,055.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.20
|
| Rate for Payer: The Alliance Commercial |
$31,108.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
HANDPIECE VERSAJET 52635
|
Facility
|
IP
|
$6,041.00
|
|
| Hospital Charge Code |
2966061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,960.09 |
| Max. Negotiated Rate |
$5,557.72 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,624.60
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
|
HANDPIECE VERSAJET 52635
|
Facility
|
OP
|
$6,041.00
|
|
| Hospital Charge Code |
2966061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,691.48 |
| Max. Negotiated Rate |
$24,164.00 |
| Rate for Payer: Aetna Commercial |
$5,436.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,195.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,691.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,926.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,020.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,899.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,201.73
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,557.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,380.54
|
| Rate for Payer: Health EOS Commercial |
$5,376.49
|
| Rate for Payer: HFN Commercial |
$5,557.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,530.75
|
| Rate for Payer: Multiplan Commercial |
$4,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,624.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,557.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,960.09
|
| Rate for Payer: Quartz Commercial |
$3,926.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,624.60
|
| Rate for Payer: The Alliance Commercial |
$24,164.00
|
| Rate for Payer: WEA Trust Commercial |
$3,322.55
|
| Rate for Payer: WPS Commercial |
$4,474.57
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2020
|
Facility
|
IP
|
$2,308.00
|
|
| Hospital Charge Code |
6178006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,130.92 |
| Max. Negotiated Rate |
$2,123.36 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,384.80
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2020
|
Facility
|
OP
|
$2,308.00
|
|
| Hospital Charge Code |
6178006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.24 |
| Max. Negotiated Rate |
$9,232.00 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Aetna Managed Medicare |
$646.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,500.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,107.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,291.56
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,731.00
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,500.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,384.80
|
| Rate for Payer: The Alliance Commercial |
$9,232.00
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2022
|
Facility
|
IP
|
$2,308.00
|
|
| Hospital Charge Code |
6216962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,130.92 |
| Max. Negotiated Rate |
$2,123.36 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,384.80
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2022
|
Facility
|
OP
|
$2,308.00
|
|
| Hospital Charge Code |
6216962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$646.24 |
| Max. Negotiated Rate |
$9,232.00 |
| Rate for Payer: Aetna Commercial |
$2,077.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,984.88
|
| Rate for Payer: Aetna Managed Medicare |
$646.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,500.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,107.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,223.24
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,123.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,291.56
|
| Rate for Payer: Health EOS Commercial |
$2,054.12
|
| Rate for Payer: HFN Commercial |
$2,123.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,731.00
|
| Rate for Payer: Multiplan Commercial |
$1,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,384.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,123.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.92
|
| Rate for Payer: Quartz Commercial |
$1,500.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,384.80
|
| Rate for Payer: The Alliance Commercial |
$9,232.00
|
| Rate for Payer: WEA Trust Commercial |
$1,269.40
|
| Rate for Payer: WPS Commercial |
$1,709.54
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$50,345.00
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$18,109.56 |
| Max. Negotiated Rate |
$50,345.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,109.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,109.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,109.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,109.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,109.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,109.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,691.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,109.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,109.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,109.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,109.56
|
| Rate for Payer: NAPHCARE Commercial |
$27,164.34
|
| Rate for Payer: Quartz Medicare Advantage |
$18,109.56
|
| Rate for Payer: The Alliance Commercial |
$50,345.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,109.56
|
| Rate for Payer: United Healthcare PPO |
$28,564.57
|
| Rate for Payer: Wellcare Medicare |
$18,109.56
|
|
|
HANDSET WITH COMMUNICATOR INTERSTIM TH90G01
|
Facility
|
IP
|
$11,202.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5459150
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5,488.98 |
| Max. Negotiated Rate |
$10,305.84 |
| Rate for Payer: Aetna Commercial |
$10,081.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,633.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,937.06
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$10,305.84
|
| Rate for Payer: Health EOS Commercial |
$9,969.78
|
| Rate for Payer: HFN Commercial |
$10,305.84
|
| Rate for Payer: Multiplan Commercial |
$8,961.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,721.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,305.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.98
|
| Rate for Payer: Quartz Commercial |
$6,721.20
|
| Rate for Payer: WEA Trust Commercial |
$6,161.10
|
| Rate for Payer: WPS Commercial |
$8,297.32
|
|
|
HANDSET WITH COMMUNICATOR INTERSTIM TH90G01
|
Facility
|
OP
|
$11,202.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5459150
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,136.56 |
| Max. Negotiated Rate |
$44,808.00 |
| Rate for Payer: Aetna Commercial |
$10,081.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,633.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,136.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,281.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,601.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,376.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,937.06
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$10,305.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,268.64
|
| Rate for Payer: Health EOS Commercial |
$9,969.78
|
| Rate for Payer: HFN Commercial |
$10,305.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,401.50
|
| Rate for Payer: Multiplan Commercial |
$8,961.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,721.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,305.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,488.98
|
| Rate for Payer: Quartz Commercial |
$7,281.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,721.20
|
| Rate for Payer: The Alliance Commercial |
$44,808.00
|
| Rate for Payer: WEA Trust Commercial |
$6,161.10
|
| Rate for Payer: WPS Commercial |
$8,297.32
|
|
|
HAND, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
HAND, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
Hand Thumb Spica Custom
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
2989892
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$227.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Aetna Managed Medicare |
$70.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.09
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$232.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.58
|
| Rate for Payer: Health EOS Commercial |
$225.17
|
| Rate for Payer: HFN Commercial |
$232.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: NAPHCARE Commercial |
$151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$232.76
|
| Rate for Payer: Quartz Beloit One Network |
$123.97
|
| Rate for Payer: Quartz Commercial |
$164.45
|
| Rate for Payer: Quartz Medicare Advantage |
$151.80
|
| Rate for Payer: The Alliance Commercial |
$1,012.00
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$187.40
|
|
|
Hand Thumb Spica Custom
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
2989892
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Aetna Commercial |
$227.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.09
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$232.76
|
| Rate for Payer: Health EOS Commercial |
$225.17
|
| Rate for Payer: HFN Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: NAPHCARE Commercial |
$151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$232.76
|
| Rate for Payer: Quartz Beloit One Network |
$123.97
|
| Rate for Payer: Quartz Commercial |
$151.80
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$187.40
|
|
|
Hantavirus Ab IgM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$51.75
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Hantavirus Ab IgM
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$62.79
|
| Rate for Payer: HFN Commercial |
$65.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$65.55
|
| Rate for Payer: Quartz Beloit One Network |
$30.36
|
| Rate for Payer: Quartz Commercial |
$39.33
|
| Rate for Payer: The Alliance Commercial |
$34.50
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Hantavirus Ab IgM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.60
|
| Rate for Payer: Health EOS Commercial |
$50.96
|
| Rate for Payer: HFN Commercial |
$53.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.20
|
| Rate for Payer: Quartz Beloit One Network |
$24.64
|
| Rate for Payer: Quartz Commercial |
$31.92
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Haptoglobin
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.00
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: HFN Commercial |
$80.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.41
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$42.50
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
