|
Haptoglobin
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$246.56 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.04
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$246.56
|
| Rate for Payer: Health EOS Commercial |
$238.52
|
| Rate for Payer: HFN Commercial |
$246.56
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: NAPHCARE Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$246.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.32
|
| Rate for Payer: Quartz Commercial |
$160.80
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Haptoglobin
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Haptoglobin
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.41 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$254.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.80
|
| Rate for Payer: Health EOS Commercial |
$243.88
|
| Rate for Payer: HFN Commercial |
$254.60
|
| 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 |
$214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$254.60
|
| Rate for Payer: Quartz Beloit One Network |
$117.92
|
| Rate for Payer: Quartz Commercial |
$152.76
|
| Rate for Payer: The Alliance Commercial |
$134.00
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Haptoglobin
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$246.56 |
| Rate for Payer: Aetna Commercial |
$241.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Aetna Managed Medicare |
$12.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.88
|
| Rate for Payer: Anthem Medicaid |
$13.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.58
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$246.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.97
|
| Rate for Payer: Dean Health Medicaid |
$13.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.58
|
| Rate for Payer: Health EOS Commercial |
$238.52
|
| Rate for Payer: HFN Commercial |
$246.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.58
|
| Rate for Payer: Managed Health Services Medicaid |
$13.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.58
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.87
|
| Rate for Payer: Preferred Network Access Commercial |
$246.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.00
|
| Rate for Payer: Quartz Beloit One Network |
$131.32
|
| Rate for Payer: Quartz Commercial |
$174.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.58
|
| Rate for Payer: The Alliance Commercial |
$50.32
|
| Rate for Payer: United Healthcare Medicaid |
$13.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare PPO |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: Wellcare Medicare |
$12.58
|
| Rate for Payer: WMAP Medicaid |
$13.00
|
| Rate for Payer: WPS Commercial |
$198.51
|
|
|
Haptoglobin
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$12.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.88
|
| Rate for Payer: Anthem Medicaid |
$13.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.58
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Dean Health Medicaid |
$13.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.58
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.58
|
| Rate for Payer: Managed Health Services Medicaid |
$13.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.58
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.87
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.00
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.58
|
| Rate for Payer: The Alliance Commercial |
$50.32
|
| Rate for Payer: United Healthcare Medicaid |
$13.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$12.58
|
| Rate for Payer: WMAP Medicaid |
$13.00
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Haptoglubin (FSURE)
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.60
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: HFN Commercial |
$91.20
|
| 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 |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Haptoglubin (FSURE)
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.88
|
| Rate for Payer: Anthem Medicaid |
$13.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.58
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Dean Health Medicaid |
$13.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.58
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.58
|
| Rate for Payer: Managed Health Services Medicaid |
$13.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.58
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.87
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.00
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12.58
|
| Rate for Payer: The Alliance Commercial |
$50.32
|
| Rate for Payer: United Healthcare Medicaid |
$13.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.58
|
| Rate for Payer: United Healthcare PPO |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: Wellcare Medicare |
$12.58
|
| Rate for Payer: WMAP Medicaid |
$13.00
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Haptoglubin (FSURE)
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
HARDWARE REMOVAL
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
HARDWARE REMOVAL
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
HARMONIC SCALPEL LAPAROSCOPIC TIP ACE HAR36
|
Facility
|
OP
|
$5,618.00
|
|
| Hospital Charge Code |
3321467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,573.04 |
| Max. Negotiated Rate |
$22,472.00 |
| Rate for Payer: Aetna Commercial |
$5,056.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,831.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,651.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,696.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,977.54
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,168.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,143.83
|
| Rate for Payer: Health EOS Commercial |
$5,000.02
|
| Rate for Payer: HFN Commercial |
$5,168.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,213.50
|
| Rate for Payer: Multiplan Commercial |
$4,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,168.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,752.82
|
| Rate for Payer: Quartz Commercial |
$3,651.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,370.80
|
| Rate for Payer: The Alliance Commercial |
$22,472.00
|
| Rate for Payer: WEA Trust Commercial |
$3,089.90
|
| Rate for Payer: WPS Commercial |
$4,161.25
|
|
|
HARMONIC SCALPEL LAPAROSCOPIC TIP ACE HAR36
|
Facility
|
IP
|
$5,618.00
|
|
| Hospital Charge Code |
3321467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,752.82 |
| Max. Negotiated Rate |
$5,168.56 |
| Rate for Payer: Aetna Commercial |
$5,056.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,831.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,977.54
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,168.56
|
| Rate for Payer: Health EOS Commercial |
$5,000.02
|
| Rate for Payer: HFN Commercial |
$5,168.56
|
| Rate for Payer: Multiplan Commercial |
$4,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,168.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,752.82
|
| Rate for Payer: Quartz Commercial |
$3,370.80
|
| Rate for Payer: WEA Trust Commercial |
$3,089.90
|
| Rate for Payer: WPS Commercial |
$4,161.25
|
|
|
HARMONIC SHEAR FOCUS CURVED SFCS9
|
Facility
|
IP
|
$7,694.00
|
|
| Hospital Charge Code |
3072602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,770.06 |
| Max. Negotiated Rate |
$7,078.48 |
| Rate for Payer: Aetna Commercial |
$6,924.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,616.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,077.82
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,078.48
|
| Rate for Payer: Health EOS Commercial |
$6,847.66
|
| Rate for Payer: HFN Commercial |
$7,078.48
|
| Rate for Payer: Multiplan Commercial |
$6,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,078.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,770.06
|
| Rate for Payer: Quartz Commercial |
$4,616.40
|
| Rate for Payer: WEA Trust Commercial |
$4,231.70
|
| Rate for Payer: WPS Commercial |
$5,698.95
|
|
|
HARMONIC SHEAR FOCUS CURVED SFCS9
|
Facility
|
OP
|
$7,694.00
|
|
| Hospital Charge Code |
3072602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,154.32 |
| Max. Negotiated Rate |
$30,776.00 |
| Rate for Payer: Aetna Commercial |
$6,924.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,616.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,154.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,001.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,847.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,693.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,077.82
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,078.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,305.56
|
| Rate for Payer: Health EOS Commercial |
$6,847.66
|
| Rate for Payer: HFN Commercial |
$7,078.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,770.50
|
| Rate for Payer: Multiplan Commercial |
$6,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,078.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,770.06
|
| Rate for Payer: Quartz Commercial |
$5,001.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,616.40
|
| Rate for Payer: The Alliance Commercial |
$30,776.00
|
| Rate for Payer: WEA Trust Commercial |
$4,231.70
|
| Rate for Payer: WPS Commercial |
$5,698.95
|
|
|
HARTMAN'S PROCEDURE
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
HARTMAN'S PROCEDURE
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
HARVESTER OSTEOAUGER BONE GRAFT 8MM ABS-8000-08
|
Facility
|
OP
|
$4,208.00
|
|
| Hospital Charge Code |
6217011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,178.24 |
| Max. Negotiated Rate |
$16,832.00 |
| Rate for Payer: Aetna Commercial |
$3,787.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,618.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,178.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,735.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,019.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,230.24
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$3,871.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.80
|
| Rate for Payer: Health EOS Commercial |
$3,745.12
|
| Rate for Payer: HFN Commercial |
$3,871.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,156.00
|
| Rate for Payer: Multiplan Commercial |
$3,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,871.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,061.92
|
| Rate for Payer: Quartz Commercial |
$2,735.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,524.80
|
| Rate for Payer: The Alliance Commercial |
$16,832.00
|
| Rate for Payer: WEA Trust Commercial |
$2,314.40
|
| Rate for Payer: WPS Commercial |
$3,116.87
|
|
|
HARVESTER OSTEOAUGER BONE GRAFT 8MM ABS-8000-08
|
Facility
|
IP
|
$4,208.00
|
|
| Hospital Charge Code |
6217011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,061.92 |
| Max. Negotiated Rate |
$3,871.36 |
| Rate for Payer: Aetna Commercial |
$3,787.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,618.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,230.24
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cigna Commercial |
$3,871.36
|
| Rate for Payer: Health EOS Commercial |
$3,745.12
|
| Rate for Payer: HFN Commercial |
$3,871.36
|
| Rate for Payer: Multiplan Commercial |
$3,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,871.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,061.92
|
| Rate for Payer: Quartz Commercial |
$2,524.80
|
| Rate for Payer: WEA Trust Commercial |
$2,314.40
|
| Rate for Payer: WPS Commercial |
$3,116.87
|
|
|
HARVESTER QUADPRO 10MM AR-2386-10
|
Facility
|
OP
|
$4,663.00
|
|
| Hospital Charge Code |
5831661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.64 |
| Max. Negotiated Rate |
$18,652.00 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,305.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,238.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,609.41
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,497.25
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$3,030.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,797.80
|
| Rate for Payer: The Alliance Commercial |
$18,652.00
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
HARVESTER QUADPRO 10MM AR-2386-10
|
Facility
|
IP
|
$4,663.00
|
|
| Hospital Charge Code |
5831661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,284.87 |
| Max. Negotiated Rate |
$4,289.96 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$2,797.80
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
HARVESTER QUADPRO 9MM AR-2386-09
|
Facility
|
OP
|
$4,663.00
|
|
| Hospital Charge Code |
5861688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.64 |
| Max. Negotiated Rate |
$18,652.00 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,305.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,331.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,238.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,609.41
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,497.25
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$3,030.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,797.80
|
| Rate for Payer: The Alliance Commercial |
$18,652.00
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
HARVESTER QUADPRO 9MM AR-2386-09
|
Facility
|
IP
|
$4,663.00
|
|
| Hospital Charge Code |
5861688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,284.87 |
| Max. Negotiated Rate |
$4,289.96 |
| Rate for Payer: Aetna Commercial |
$4,196.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.39
|
| Rate for Payer: Cash Price |
$1,398.90
|
| Rate for Payer: Cigna Commercial |
$4,289.96
|
| Rate for Payer: Health EOS Commercial |
$4,150.07
|
| Rate for Payer: HFN Commercial |
$4,289.96
|
| Rate for Payer: Multiplan Commercial |
$3,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,797.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,289.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,284.87
|
| Rate for Payer: Quartz Commercial |
$2,797.80
|
| Rate for Payer: WEA Trust Commercial |
$2,564.65
|
| Rate for Payer: WPS Commercial |
$3,453.88
|
|
|
HARVESTING SYSTEM FASTGRAFTER (7MM FASTGRAFTER & PUSHER INSTRUMENT) SK27
|
Facility
|
IP
|
$7,087.00
|
|
| Hospital Charge Code |
6175180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,472.63 |
| Max. Negotiated Rate |
$6,520.04 |
| Rate for Payer: Aetna Commercial |
$6,378.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,094.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,756.11
|
| Rate for Payer: Cash Price |
$2,126.10
|
| Rate for Payer: Cigna Commercial |
$6,520.04
|
| Rate for Payer: Health EOS Commercial |
$6,307.43
|
| Rate for Payer: HFN Commercial |
$6,520.04
|
| Rate for Payer: Multiplan Commercial |
$5,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,252.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,520.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,472.63
|
| Rate for Payer: Quartz Commercial |
$4,252.20
|
| Rate for Payer: WEA Trust Commercial |
$3,897.85
|
| Rate for Payer: WPS Commercial |
$5,249.34
|
|
|
HARVESTING SYSTEM FASTGRAFTER (7MM FASTGRAFTER & PUSHER INSTRUMENT) SK27
|
Facility
|
OP
|
$7,087.00
|
|
| Hospital Charge Code |
6175180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,984.36 |
| Max. Negotiated Rate |
$28,348.00 |
| Rate for Payer: Aetna Commercial |
$6,378.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,094.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,984.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,606.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,543.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,401.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,756.11
|
| Rate for Payer: Cash Price |
$2,126.10
|
| Rate for Payer: Cigna Commercial |
$6,520.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,965.89
|
| Rate for Payer: Health EOS Commercial |
$6,307.43
|
| Rate for Payer: HFN Commercial |
$6,520.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,315.25
|
| Rate for Payer: Multiplan Commercial |
$5,669.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,252.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,520.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,472.63
|
| Rate for Payer: Quartz Commercial |
$4,606.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4,252.20
|
| Rate for Payer: The Alliance Commercial |
$28,348.00
|
| Rate for Payer: WEA Trust Commercial |
$3,897.85
|
| Rate for Payer: WPS Commercial |
$5,249.34
|
|
|
HAWKIN II W/HARDWIRE 20gX10cm #242100
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2973461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$2,728.00 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Aetna Managed Medicare |
$190.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.65
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.50
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$443.30
|
| Rate for Payer: Quartz Medicare Advantage |
$409.20
|
| Rate for Payer: The Alliance Commercial |
$2,728.00
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
