|
HAWKIN II W/HARDWIRE 20gX10cm #242100
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2973461
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$627.44 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| 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: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| 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 |
$409.20
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
Hb Variant Mass Spec
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$675.45 |
| Rate for Payer: Aetna Commercial |
$675.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.46
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$675.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$355.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.60
|
| Rate for Payer: Health EOS Commercial |
$647.01
|
| Rate for Payer: HFN Commercial |
$675.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.11
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Preferred Network Access Commercial |
$675.45
|
| Rate for Payer: Quartz Beloit One Network |
$312.84
|
| Rate for Payer: Quartz Commercial |
$405.27
|
| Rate for Payer: The Alliance Commercial |
$355.50
|
| Rate for Payer: WEA Trust Commercial |
$391.05
|
| Rate for Payer: WPS Commercial |
$526.64
|
|
|
Hb Variant Mass Spec
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$348.39 |
| Max. Negotiated Rate |
$654.12 |
| Rate for Payer: Aetna Commercial |
$639.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.83
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$654.12
|
| Rate for Payer: Health EOS Commercial |
$632.79
|
| Rate for Payer: HFN Commercial |
$654.12
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: NAPHCARE Commercial |
$426.60
|
| Rate for Payer: Preferred Network Access Commercial |
$654.12
|
| Rate for Payer: Quartz Beloit One Network |
$348.39
|
| Rate for Payer: Quartz Commercial |
$426.60
|
| Rate for Payer: WEA Trust Commercial |
$391.05
|
| Rate for Payer: WPS Commercial |
$526.64
|
|
|
Hb Variant Mass Spec
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
5595447
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$654.12 |
| Rate for Payer: Aetna Commercial |
$639.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.46
|
| Rate for Payer: Aetna Managed Medicare |
$24.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.02
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.11
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$654.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$397.88
|
| Rate for Payer: Dean Health Medicaid |
$24.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.11
|
| Rate for Payer: Health EOS Commercial |
$632.79
|
| Rate for Payer: HFN Commercial |
$654.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.11
|
| Rate for Payer: Managed Health Services Medicaid |
$25.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.16
|
| Rate for Payer: Preferred Network Access Commercial |
$654.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.91
|
| Rate for Payer: Quartz Beloit One Network |
$348.39
|
| Rate for Payer: Quartz Commercial |
$462.15
|
| Rate for Payer: Quartz Medicare Advantage |
$24.11
|
| Rate for Payer: The Alliance Commercial |
$96.44
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Healthcare PPO |
$533.25
|
| Rate for Payer: WEA Trust Commercial |
$391.05
|
| Rate for Payer: Wellcare Medicare |
$24.11
|
| Rate for Payer: WMAP Medicaid |
$24.91
|
| Rate for Payer: WPS Commercial |
$526.64
|
|
|
HCG, Serum
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2942984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
HCG, Serum
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2942984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
HCG, Serum
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
2942984
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.80
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: HFN Commercial |
$145.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
HE4, Ovarian Cancer Monitoring
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
1039141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.85
|
| Rate for Payer: Dean Health Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$22.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.50
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$83.24
|
| Rate for Payer: United Healthcare Medicaid |
$21.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$426.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$21.50
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
HE4, Ovarian Cancer Monitoring
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
1039141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
HE4, Ovarian Cancer Monitoring
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
CPT 86305
|
| Hospital Charge Code |
1039141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Aetna Commercial |
$539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$539.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.80
|
| Rate for Payer: Health EOS Commercial |
$516.88
|
| Rate for Payer: HFN Commercial |
$539.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: Preferred Network Access Commercial |
$539.60
|
| Rate for Payer: Quartz Beloit One Network |
$249.92
|
| Rate for Payer: Quartz Commercial |
$323.76
|
| Rate for Payer: The Alliance Commercial |
$284.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
HEAD 18MM EVOLVE RADIAL
|
Facility
|
IP
|
$12,439.00
|
|
| Hospital Charge Code |
2967398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,095.11 |
| Max. Negotiated Rate |
$11,443.88 |
| Rate for Payer: Aetna Commercial |
$11,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,697.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,592.67
|
| Rate for Payer: Cash Price |
$3,731.70
|
| Rate for Payer: Cigna Commercial |
$11,443.88
|
| Rate for Payer: Health EOS Commercial |
$11,070.71
|
| Rate for Payer: HFN Commercial |
$11,443.88
|
| Rate for Payer: Multiplan Commercial |
$9,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,443.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,095.11
|
| Rate for Payer: Quartz Commercial |
$7,463.40
|
| Rate for Payer: WEA Trust Commercial |
$6,841.45
|
| Rate for Payer: WPS Commercial |
$9,213.57
|
|
|
HEAD 18MM EVOLVE RADIAL
|
Facility
|
OP
|
$12,439.00
|
|
| Hospital Charge Code |
2967398
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,482.92 |
| Max. Negotiated Rate |
$49,756.00 |
| Rate for Payer: Aetna Commercial |
$11,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,697.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,482.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,085.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,970.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,592.67
|
| Rate for Payer: Cash Price |
$3,731.70
|
| Rate for Payer: Cigna Commercial |
$11,443.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,960.86
|
| Rate for Payer: Health EOS Commercial |
$11,070.71
|
| Rate for Payer: HFN Commercial |
$11,443.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,329.25
|
| Rate for Payer: Multiplan Commercial |
$9,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,443.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,095.11
|
| Rate for Payer: Quartz Commercial |
$8,085.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,463.40
|
| Rate for Payer: The Alliance Commercial |
$49,756.00
|
| Rate for Payer: WEA Trust Commercial |
$6,841.45
|
| Rate for Payer: WPS Commercial |
$9,213.57
|
|
|
HEAD 46/17.25 HUMERAL
|
Facility
|
OP
|
$13,932.00
|
|
| Hospital Charge Code |
2966252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,900.96 |
| Max. Negotiated Rate |
$55,728.00 |
| Rate for Payer: Aetna Commercial |
$12,538.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,981.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,900.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,055.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,966.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,687.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,383.96
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$12,817.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,796.35
|
| Rate for Payer: Health EOS Commercial |
$12,399.48
|
| Rate for Payer: HFN Commercial |
$12,817.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,449.00
|
| Rate for Payer: Multiplan Commercial |
$11,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,817.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,826.68
|
| Rate for Payer: Quartz Commercial |
$9,055.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,359.20
|
| Rate for Payer: The Alliance Commercial |
$55,728.00
|
| Rate for Payer: WEA Trust Commercial |
$7,662.60
|
| Rate for Payer: WPS Commercial |
$10,319.43
|
|
|
HEAD 46/17.25 HUMERAL
|
Facility
|
IP
|
$13,932.00
|
|
| Hospital Charge Code |
2966252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.68 |
| Max. Negotiated Rate |
$12,817.44 |
| Rate for Payer: Aetna Commercial |
$12,538.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,981.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,383.96
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$12,817.44
|
| Rate for Payer: Health EOS Commercial |
$12,399.48
|
| Rate for Payer: HFN Commercial |
$12,817.44
|
| Rate for Payer: Multiplan Commercial |
$11,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,817.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,826.68
|
| Rate for Payer: Quartz Commercial |
$8,359.20
|
| Rate for Payer: WEA Trust Commercial |
$7,662.60
|
| Rate for Payer: WPS Commercial |
$10,319.43
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$32,399.00
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$11,654.34 |
| Max. Negotiated Rate |
$32,399.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,654.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,385.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,458.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,486.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11,654.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,654.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,654.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,654.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,521.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,654.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,528.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,654.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,654.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,654.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,654.34
|
| Rate for Payer: NAPHCARE Commercial |
$17,481.51
|
| Rate for Payer: Quartz Medicare Advantage |
$11,654.34
|
| Rate for Payer: The Alliance Commercial |
$32,399.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,654.34
|
| Rate for Payer: United Healthcare PPO |
$18,317.39
|
| Rate for Payer: Wellcare Medicare |
$11,654.34
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$22,716.00
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$8,171.38 |
| Max. Negotiated Rate |
$22,716.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,171.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,623.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,508.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,833.52
|
| Rate for Payer: Anthem Medicare Advantage |
$8,171.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,171.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,171.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,171.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,246.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,171.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,426.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,171.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,171.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,171.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,171.38
|
| Rate for Payer: NAPHCARE Commercial |
$12,257.07
|
| Rate for Payer: Quartz Medicare Advantage |
$8,171.38
|
| Rate for Payer: The Alliance Commercial |
$22,716.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,171.38
|
| Rate for Payer: United Healthcare PPO |
$12,788.47
|
| Rate for Payer: Wellcare Medicare |
$8,171.38
|
|
|
HEADBAND TFI SENSOR #1608
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2974459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
HEADBAND TFI SENSOR #1608
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2974459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
HEAD COMPONENT EVOLVE 22mm 496-H022
|
Facility
|
OP
|
$12,439.00
|
|
| Hospital Charge Code |
2967399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,482.92 |
| Max. Negotiated Rate |
$49,756.00 |
| Rate for Payer: Aetna Commercial |
$11,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,697.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,482.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,085.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,970.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,592.67
|
| Rate for Payer: Cash Price |
$3,731.70
|
| Rate for Payer: Cigna Commercial |
$11,443.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,960.86
|
| Rate for Payer: Health EOS Commercial |
$11,070.71
|
| Rate for Payer: HFN Commercial |
$11,443.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,329.25
|
| Rate for Payer: Multiplan Commercial |
$9,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,443.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,095.11
|
| Rate for Payer: Quartz Commercial |
$8,085.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7,463.40
|
| Rate for Payer: The Alliance Commercial |
$49,756.00
|
| Rate for Payer: WEA Trust Commercial |
$6,841.45
|
| Rate for Payer: WPS Commercial |
$9,213.57
|
|
|
HEAD COMPONENT EVOLVE 22mm 496-H022
|
Facility
|
IP
|
$12,439.00
|
|
| Hospital Charge Code |
2967399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,095.11 |
| Max. Negotiated Rate |
$11,443.88 |
| Rate for Payer: Aetna Commercial |
$11,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,697.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,592.67
|
| Rate for Payer: Cash Price |
$3,731.70
|
| Rate for Payer: Cigna Commercial |
$11,443.88
|
| Rate for Payer: Health EOS Commercial |
$11,070.71
|
| Rate for Payer: HFN Commercial |
$11,443.88
|
| Rate for Payer: Multiplan Commercial |
$9,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,443.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,095.11
|
| Rate for Payer: Quartz Commercial |
$7,463.40
|
| Rate for Payer: WEA Trust Commercial |
$6,841.45
|
| Rate for Payer: WPS Commercial |
$9,213.57
|
|
|
HEAD COMPONENT UNITRAX ENDOPROSTHESIS 38MM 6942-5-038
|
Facility
|
OP
|
$4,878.00
|
|
| Hospital Charge Code |
4518646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.84 |
| Max. Negotiated Rate |
$19,512.00 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,365.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,170.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,439.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,341.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,729.73
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,658.50
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$3,170.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,926.80
|
| Rate for Payer: The Alliance Commercial |
$19,512.00
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
HEAD COMPONENT UNITRAX ENDOPROSTHESIS 38MM 6942-5-038
|
Facility
|
IP
|
$4,878.00
|
|
| Hospital Charge Code |
4518646
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.22 |
| Max. Negotiated Rate |
$4,487.76 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$2,926.80
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
HEAD COMPONENT UNITRAX ENDOPROSTHESIS 39MM 6942-5-039
|
Facility
|
OP
|
$4,878.00
|
|
| Hospital Charge Code |
4388404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.84 |
| Max. Negotiated Rate |
$19,512.00 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,365.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,170.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,439.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,341.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,729.73
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,658.50
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$3,170.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,926.80
|
| Rate for Payer: The Alliance Commercial |
$19,512.00
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
HEAD COMPONENT UNITRAX ENDOPROSTHESIS 39MM 6942-5-039
|
Facility
|
IP
|
$4,878.00
|
|
| Hospital Charge Code |
4388404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.22 |
| Max. Negotiated Rate |
$4,487.76 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$2,926.80
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
|
HEAD COMPONENT UNITRAX ENDOPROSTHESIS 40MM 6942-5-040
|
Facility
|
IP
|
$4,878.00
|
|
| Hospital Charge Code |
4518647
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.22 |
| Max. Negotiated Rate |
$4,487.76 |
| Rate for Payer: Aetna Commercial |
$4,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,195.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,585.34
|
| Rate for Payer: Cash Price |
$1,463.40
|
| Rate for Payer: Cigna Commercial |
$4,487.76
|
| Rate for Payer: Health EOS Commercial |
$4,341.42
|
| Rate for Payer: HFN Commercial |
$4,487.76
|
| Rate for Payer: Multiplan Commercial |
$3,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,926.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,487.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,390.22
|
| Rate for Payer: Quartz Commercial |
$2,926.80
|
| Rate for Payer: WEA Trust Commercial |
$2,682.90
|
| Rate for Payer: WPS Commercial |
$3,613.13
|
|
