|
HEART RETURN, OPEN
|
Facility
|
OP
|
$15,504.00
|
|
| Hospital Charge Code |
2960526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,514.76 |
| Max. Negotiated Rate |
$14,834.23 |
| Rate for Payer: Aetna Commercial |
$14,511.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,866.78
|
| Rate for Payer: Aetna Managed Medicare |
$4,514.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,480.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,062.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,739.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,545.80
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,834.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,023.33
|
| Rate for Payer: Health EOS Commercial |
$14,350.50
|
| Rate for Payer: HFN Commercial |
$14,834.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,093.12
|
| Rate for Payer: Multiplan Commercial |
$12,899.33
|
| Rate for Payer: NAPHCARE Commercial |
$9,674.50
|
| Rate for Payer: Preferred Network Access Commercial |
$14,834.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,900.84
|
| Rate for Payer: Quartz Commercial |
$10,480.70
|
| Rate for Payer: Quartz Medicare Advantage |
$9,674.50
|
| Rate for Payer: The Alliance Commercial |
$8,062.08
|
| Rate for Payer: WEA Trust Commercial |
$8,868.29
|
| Rate for Payer: WPS Commercial |
$11,942.73
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$749,593.52
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$215,119.31 |
| Max. Negotiated Rate |
$749,593.52 |
| Rate for Payer: Aetna Managed Medicare |
$215,119.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611,459.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468,678.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$445,275.11
|
| Rate for Payer: Anthem Medicare Advantage |
$215,119.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$215,119.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$215,119.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$215,119.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494,296.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$215,119.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549,559.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215,119.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$215,119.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$215,119.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$215,119.31
|
| Rate for Payer: NAPHCARE Commercial |
$322,678.96
|
| Rate for Payer: Quartz Medicare Advantage |
$215,119.31
|
| Rate for Payer: The Alliance Commercial |
$749,593.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$215,119.31
|
| Rate for Payer: Wellcare Medicare |
$215,119.31
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$338,875.68
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$87,287.93 |
| Max. Negotiated Rate |
$338,875.68 |
| Rate for Payer: Aetna Managed Medicare |
$87,287.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247,250.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189,515.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180,052.33
|
| Rate for Payer: Anthem Medicare Advantage |
$87,287.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87,287.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87,287.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$87,287.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199,874.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$87,287.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248,310.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87,287.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87,287.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$87,287.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$87,287.93
|
| Rate for Payer: NAPHCARE Commercial |
$130,931.89
|
| Rate for Payer: Quartz Medicare Advantage |
$87,287.93
|
| Rate for Payer: The Alliance Commercial |
$338,875.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87,287.93
|
| Rate for Payer: United Healthcare PPO |
$193,312.79
|
| Rate for Payer: Wellcare Medicare |
$87,287.93
|
|
|
HEART VALVE 21mm MOSAIC PORCIN
|
Facility
|
IP
|
$50,031.00
|
|
| Hospital Charge Code |
2965346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,495.80 |
| Max. Negotiated Rate |
$47,869.66 |
| Rate for Payer: Aetna Commercial |
$46,829.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44,747.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,577.09
|
| Rate for Payer: Cash Price |
$15,009.30
|
| Rate for Payer: Cigna Commercial |
$47,869.66
|
| Rate for Payer: Health EOS Commercial |
$46,308.69
|
| Rate for Payer: HFN Commercial |
$47,869.66
|
| Rate for Payer: Multiplan Commercial |
$41,625.79
|
| Rate for Payer: Preferred Network Access Commercial |
$47,869.66
|
| Rate for Payer: Quartz Beloit One Network |
$25,495.80
|
| Rate for Payer: Quartz Commercial |
$31,219.34
|
| Rate for Payer: WEA Trust Commercial |
$28,617.73
|
| Rate for Payer: WPS Commercial |
$38,538.88
|
|
|
HEART VALVE 21mm MOSAIC PORCIN
|
Facility
|
OP
|
$50,031.00
|
|
| Hospital Charge Code |
2965346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,569.03 |
| Max. Negotiated Rate |
$47,869.66 |
| Rate for Payer: Aetna Commercial |
$46,829.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44,747.73
|
| Rate for Payer: Aetna Managed Medicare |
$14,569.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,820.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,016.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,975.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,577.09
|
| Rate for Payer: Cash Price |
$15,009.30
|
| Rate for Payer: Cigna Commercial |
$47,869.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,118.04
|
| Rate for Payer: Health EOS Commercial |
$46,308.69
|
| Rate for Payer: HFN Commercial |
$47,869.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,024.18
|
| Rate for Payer: Multiplan Commercial |
$41,625.79
|
| Rate for Payer: NAPHCARE Commercial |
$31,219.34
|
| Rate for Payer: Preferred Network Access Commercial |
$47,869.66
|
| Rate for Payer: Quartz Beloit One Network |
$25,495.80
|
| Rate for Payer: Quartz Commercial |
$33,820.96
|
| Rate for Payer: Quartz Medicare Advantage |
$31,219.34
|
| Rate for Payer: The Alliance Commercial |
$26,016.12
|
| Rate for Payer: WEA Trust Commercial |
$28,617.73
|
| Rate for Payer: WPS Commercial |
$38,538.88
|
|
|
HEART VALVE 31MM MECHANICAL #500DM31
|
Facility
|
IP
|
$29,013.00
|
|
| Hospital Charge Code |
2973944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,785.02 |
| Max. Negotiated Rate |
$27,759.64 |
| Rate for Payer: Aetna Commercial |
$27,156.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,949.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,991.97
|
| Rate for Payer: Cash Price |
$8,703.90
|
| Rate for Payer: Cigna Commercial |
$27,759.64
|
| Rate for Payer: Health EOS Commercial |
$26,854.43
|
| Rate for Payer: HFN Commercial |
$27,759.64
|
| Rate for Payer: Multiplan Commercial |
$24,138.82
|
| Rate for Payer: Preferred Network Access Commercial |
$27,759.64
|
| Rate for Payer: Quartz Beloit One Network |
$14,785.02
|
| Rate for Payer: Quartz Commercial |
$18,104.11
|
| Rate for Payer: WEA Trust Commercial |
$16,595.44
|
| Rate for Payer: WPS Commercial |
$22,348.71
|
|
|
HEART VALVE 31MM MECHANICAL #500DM31
|
Facility
|
OP
|
$29,013.00
|
|
| Hospital Charge Code |
2973944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,448.59 |
| Max. Negotiated Rate |
$27,759.64 |
| Rate for Payer: Aetna Commercial |
$27,156.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,949.23
|
| Rate for Payer: Aetna Managed Medicare |
$8,448.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,612.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,086.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,483.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,991.97
|
| Rate for Payer: Cash Price |
$8,703.90
|
| Rate for Payer: Cigna Commercial |
$27,759.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,885.57
|
| Rate for Payer: Health EOS Commercial |
$26,854.43
|
| Rate for Payer: HFN Commercial |
$27,759.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,630.14
|
| Rate for Payer: Multiplan Commercial |
$24,138.82
|
| Rate for Payer: NAPHCARE Commercial |
$18,104.11
|
| Rate for Payer: Preferred Network Access Commercial |
$27,759.64
|
| Rate for Payer: Quartz Beloit One Network |
$14,785.02
|
| Rate for Payer: Quartz Commercial |
$19,612.79
|
| Rate for Payer: Quartz Medicare Advantage |
$18,104.11
|
| Rate for Payer: The Alliance Commercial |
$15,086.76
|
| Rate for Payer: WEA Trust Commercial |
$16,595.44
|
| Rate for Payer: WPS Commercial |
$22,348.71
|
|
|
HEART VALVE 31mm MOSAIC PORCIN
|
Facility
|
IP
|
$47,591.00
|
|
| Hospital Charge Code |
2965347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,252.37 |
| Max. Negotiated Rate |
$45,535.07 |
| Rate for Payer: Aetna Commercial |
$44,545.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,565.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,232.16
|
| Rate for Payer: Cash Price |
$14,277.30
|
| Rate for Payer: Cigna Commercial |
$45,535.07
|
| Rate for Payer: Health EOS Commercial |
$44,050.23
|
| Rate for Payer: HFN Commercial |
$45,535.07
|
| Rate for Payer: Multiplan Commercial |
$39,595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$45,535.07
|
| Rate for Payer: Quartz Beloit One Network |
$24,252.37
|
| Rate for Payer: Quartz Commercial |
$29,696.78
|
| Rate for Payer: WEA Trust Commercial |
$27,222.05
|
| Rate for Payer: WPS Commercial |
$36,659.35
|
|
|
HEART VALVE 31mm MOSAIC PORCIN
|
Facility
|
OP
|
$47,591.00
|
|
| Hospital Charge Code |
2965347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,858.50 |
| Max. Negotiated Rate |
$45,535.07 |
| Rate for Payer: Aetna Commercial |
$44,545.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,565.39
|
| Rate for Payer: Aetna Managed Medicare |
$13,858.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,171.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,747.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,757.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,232.16
|
| Rate for Payer: Cash Price |
$14,277.30
|
| Rate for Payer: Cigna Commercial |
$45,535.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,697.96
|
| Rate for Payer: Health EOS Commercial |
$44,050.23
|
| Rate for Payer: HFN Commercial |
$45,535.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,120.98
|
| Rate for Payer: Multiplan Commercial |
$39,595.71
|
| Rate for Payer: NAPHCARE Commercial |
$29,696.78
|
| Rate for Payer: Preferred Network Access Commercial |
$45,535.07
|
| Rate for Payer: Quartz Beloit One Network |
$24,252.37
|
| Rate for Payer: Quartz Commercial |
$32,171.52
|
| Rate for Payer: Quartz Medicare Advantage |
$29,696.78
|
| Rate for Payer: The Alliance Commercial |
$24,747.32
|
| Rate for Payer: WEA Trust Commercial |
$27,222.05
|
| Rate for Payer: WPS Commercial |
$36,659.35
|
|
|
HEART VALVE PERICARDIAL TISSUE
|
Facility
|
OP
|
$45,119.00
|
|
| Hospital Charge Code |
2965104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,138.65 |
| Max. Negotiated Rate |
$43,169.86 |
| Rate for Payer: Aetna Commercial |
$42,231.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,354.43
|
| Rate for Payer: Aetna Managed Medicare |
$13,138.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,500.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,461.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,523.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,869.59
|
| Rate for Payer: Cash Price |
$13,535.70
|
| Rate for Payer: Cigna Commercial |
$43,169.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,259.26
|
| Rate for Payer: Health EOS Commercial |
$41,762.15
|
| Rate for Payer: HFN Commercial |
$43,169.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,192.82
|
| Rate for Payer: Multiplan Commercial |
$37,539.01
|
| Rate for Payer: NAPHCARE Commercial |
$28,154.26
|
| Rate for Payer: Preferred Network Access Commercial |
$43,169.86
|
| Rate for Payer: Quartz Beloit One Network |
$22,992.64
|
| Rate for Payer: Quartz Commercial |
$30,500.44
|
| Rate for Payer: Quartz Medicare Advantage |
$28,154.26
|
| Rate for Payer: The Alliance Commercial |
$23,461.88
|
| Rate for Payer: WEA Trust Commercial |
$25,808.07
|
| Rate for Payer: WPS Commercial |
$34,755.17
|
|
|
HEART VALVE PERICARDIAL TISSUE
|
Facility
|
IP
|
$45,119.00
|
|
| Hospital Charge Code |
2965104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,992.64 |
| Max. Negotiated Rate |
$43,169.86 |
| Rate for Payer: Aetna Commercial |
$42,231.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,354.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,869.59
|
| Rate for Payer: Cash Price |
$13,535.70
|
| Rate for Payer: Cigna Commercial |
$43,169.86
|
| Rate for Payer: Health EOS Commercial |
$41,762.15
|
| Rate for Payer: HFN Commercial |
$43,169.86
|
| Rate for Payer: Multiplan Commercial |
$37,539.01
|
| Rate for Payer: Preferred Network Access Commercial |
$43,169.86
|
| Rate for Payer: Quartz Beloit One Network |
$22,992.64
|
| Rate for Payer: Quartz Commercial |
$28,154.26
|
| Rate for Payer: WEA Trust Commercial |
$25,808.07
|
| Rate for Payer: WPS Commercial |
$34,755.17
|
|
|
HEART VALVE REPLACEMENT
|
Facility
|
IP
|
$15,894.00
|
|
| Hospital Charge Code |
2960492
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,099.58 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$9,917.86
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
HEART VALVE REPLACEMENT
|
Facility
|
OP
|
$15,894.00
|
|
| Hospital Charge Code |
2960492
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,628.33 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,628.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,744.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,264.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,934.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,250.31
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,397.32
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: NAPHCARE Commercial |
$9,917.86
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$10,744.34
|
| Rate for Payer: Quartz Medicare Advantage |
$9,917.86
|
| Rate for Payer: The Alliance Commercial |
$8,264.88
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
Heavy Metal Screen
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Heavy Metal Screen
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$21.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.15
|
| Rate for Payer: Anthem Medicare Advantage |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.78
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.78
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.78
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$32.67
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: Quartz Medicare Advantage |
$21.78
|
| Rate for Payer: The Alliance Commercial |
$87.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.78
|
| Rate for Payer: United Healthcare PPO |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: Wellcare Medicare |
$21.78
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Heavy Metal Screen
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977960
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Aetna Commercial |
$355.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$21.78
|
| Rate for Payer: Anthem Medicare Advantage |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.78
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$355.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.78
|
| Rate for Payer: Health EOS Commercial |
$340.70
|
| Rate for Payer: HFN Commercial |
$355.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.78
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$32.67
|
| Rate for Payer: Preferred Network Access Commercial |
$355.68
|
| Rate for Payer: Quartz Beloit One Network |
$164.74
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: Quartz Medicare Advantage |
$21.78
|
| Rate for Payer: The Alliance Commercial |
$86.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.78
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$95.82
|
|
|
Heavy Metals Panel w/ Cadmium, Random Urine
|
Facility
|
OP
|
$240.45
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
3986158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$230.06 |
| Rate for Payer: Aetna Commercial |
$225.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.06
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cigna Commercial |
$230.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$222.56
|
| Rate for Payer: HFN Commercial |
$230.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$200.05
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$230.06
|
| Rate for Payer: Quartz Beloit One Network |
$122.53
|
| Rate for Payer: Quartz Commercial |
$162.54
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$187.55
|
| Rate for Payer: WEA Trust Commercial |
$137.54
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$185.22
|
|
|
Heavy Metals Panel w/ Cadmium, Random Urine
|
Professional
|
Both
|
$240.45
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
3986158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$237.56 |
| Rate for Payer: Aetna Commercial |
$237.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.06
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cigna Commercial |
$237.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$227.56
|
| Rate for Payer: HFN Commercial |
$237.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$200.05
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$237.56
|
| Rate for Payer: Quartz Beloit One Network |
$110.03
|
| Rate for Payer: Quartz Commercial |
$142.54
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$137.54
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
Heavy Metals Panel w/ Cadmium, Random Urine
|
Facility
|
IP
|
$240.45
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
3986158
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.53 |
| Max. Negotiated Rate |
$230.06 |
| Rate for Payer: Aetna Commercial |
$225.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.54
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cigna Commercial |
$230.06
|
| Rate for Payer: Health EOS Commercial |
$222.56
|
| Rate for Payer: HFN Commercial |
$230.06
|
| Rate for Payer: Multiplan Commercial |
$200.05
|
| Rate for Payer: Preferred Network Access Commercial |
$230.06
|
| Rate for Payer: Quartz Beloit One Network |
$122.53
|
| Rate for Payer: Quartz Commercial |
$150.04
|
| Rate for Payer: WEA Trust Commercial |
$137.54
|
| Rate for Payer: WPS Commercial |
$185.22
|
|
|
Hectoral 1mcg
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
3005562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Hectoral 1mcg
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
3005562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$16.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.15
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.90
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$34.32
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$34.32
|
| Rate for Payer: The Alliance Commercial |
$1.29
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$2.17
|
|
|
HEEL CUP LARGE #TU10020
|
Facility
|
OP
|
$194.00
|
|
| Hospital Charge Code |
2974296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$56.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.32
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$121.06
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.06
|
| Rate for Payer: The Alliance Commercial |
$100.88
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
HEEL CUP LARGE #TU10020
|
Facility
|
IP
|
$194.00
|
|
| Hospital Charge Code |
2974296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
HEEL CUP REGULAR #TU10010
|
Facility
|
IP
|
$194.00
|
|
| Hospital Charge Code |
2974295
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
HEEL CUP REGULAR #TU10010
|
Facility
|
OP
|
$194.00
|
|
| Hospital Charge Code |
2974295
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$56.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.32
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$121.06
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.06
|
| Rate for Payer: The Alliance Commercial |
$100.88
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
