|
Interleukin 6 High Sensitive, ELISA
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.82 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.54
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| Rate for Payer: Health EOS Commercial |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| Rate for Payer: Multiplan Commercial |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$190.80
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$190.80
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
Intermediate Joint 20605 - Admin Intra-articular Injection Charge
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
3475533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.19
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: United Healthcare Medicaid |
$49.56
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Intermediate Joint 20605 - Admin Intra-articular Injection Charge
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
3475533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$167.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Intermediate Joint 20605 - Admin Intra-articular Injection Charge
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
3475533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
Intermediate Observation Per Hour
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040436
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Intermediate Observation Per Hour
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040436
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,992.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,030.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,729.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$49.80
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: United Healthcare PPO |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Intermittent Self Cath
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.19 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$198.60
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Intermittent Self Cath
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$1,324.00 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Aetna Managed Medicare |
$92.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$215.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.23
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.25
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$215.15
|
| Rate for Payer: Quartz Medicare Advantage |
$198.60
|
| Rate for Payer: The Alliance Commercial |
$1,324.00
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Interp & Report
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Interp & Report
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Interp & Report
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$31.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
INTERPULSE HANDPIECE NO TIP 210-100
|
Facility
|
OP
|
$703.00
|
|
| Hospital Charge Code |
2963643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.84 |
| Max. Negotiated Rate |
$2,812.00 |
| Rate for Payer: Aetna Commercial |
$632.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$604.58
|
| Rate for Payer: Aetna Managed Medicare |
$196.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.59
|
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Cigna Commercial |
$646.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.40
|
| Rate for Payer: Health EOS Commercial |
$625.67
|
| Rate for Payer: HFN Commercial |
$646.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$527.25
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: NAPHCARE Commercial |
$421.80
|
| Rate for Payer: Preferred Network Access Commercial |
$646.76
|
| Rate for Payer: Quartz Beloit One Network |
$344.47
|
| Rate for Payer: Quartz Commercial |
$456.95
|
| Rate for Payer: Quartz Medicare Advantage |
$421.80
|
| Rate for Payer: The Alliance Commercial |
$2,812.00
|
| Rate for Payer: WEA Trust Commercial |
$386.65
|
| Rate for Payer: WPS Commercial |
$520.71
|
|
|
INTERPULSE HANDPIECE NO TIP 210-100
|
Facility
|
IP
|
$703.00
|
|
| Hospital Charge Code |
2963643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.47 |
| Max. Negotiated Rate |
$646.76 |
| Rate for Payer: Aetna Commercial |
$632.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$604.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.59
|
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Cigna Commercial |
$646.76
|
| Rate for Payer: Health EOS Commercial |
$625.67
|
| Rate for Payer: HFN Commercial |
$646.76
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: NAPHCARE Commercial |
$421.80
|
| Rate for Payer: Preferred Network Access Commercial |
$646.76
|
| Rate for Payer: Quartz Beloit One Network |
$344.47
|
| Rate for Payer: Quartz Commercial |
$421.80
|
| Rate for Payer: WEA Trust Commercial |
$386.65
|
| Rate for Payer: WPS Commercial |
$520.71
|
|
|
INTERPULSE LAVAGE W/TIP SOFT TISSUE 210-118-200
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
5264677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
INTERPULSE LAVAGE W/TIP SOFT TISSUE 210-118-200
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
5264677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
INTERPULSE PULSAVAC BONE 0210-110-000
|
Facility
|
IP
|
$1,022.00
|
|
| Hospital Charge Code |
2963041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.78 |
| Max. Negotiated Rate |
$940.24 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| Rate for Payer: Health EOS Commercial |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$613.20
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| Rate for Payer: Quartz Commercial |
$613.20
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: WPS Commercial |
$757.00
|
|
|
INTERPULSE PULSAVAC BONE 0210-110-000
|
Facility
|
OP
|
$1,022.00
|
|
| Hospital Charge Code |
2963041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.16 |
| Max. Negotiated Rate |
$4,088.00 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.92
|
| Rate for Payer: Aetna Managed Medicare |
$286.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.91
|
| Rate for Payer: Health EOS Commercial |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$613.20
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| Rate for Payer: Quartz Commercial |
$664.30
|
| Rate for Payer: Quartz Medicare Advantage |
$613.20
|
| Rate for Payer: The Alliance Commercial |
$4,088.00
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: WPS Commercial |
$757.00
|
|
|
Interrogation Device Eval 93288
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
3354934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Commercial |
$741.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$741.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.00
|
| Rate for Payer: Health EOS Commercial |
$709.80
|
| Rate for Payer: HFN Commercial |
$741.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.13
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$741.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.20
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: The Alliance Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.13
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
Interrogation Device Eval 9328826
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 93288 26
|
| Hospital Charge Code |
3137563
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Aetna Commercial |
$741.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$741.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.00
|
| Rate for Payer: Health EOS Commercial |
$709.80
|
| Rate for Payer: HFN Commercial |
$741.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.91
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$741.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.20
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: The Alliance Commercial |
$390.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.13
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
Interrogation Device Evaluation, In Person With Physician Evaluation Cardioverter-Defibrilator Syste
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
1190896
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$337.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$337.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.00
|
| Rate for Payer: Health EOS Commercial |
$323.05
|
| Rate for Payer: HFN Commercial |
$337.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.89
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Preferred Network Access Commercial |
$337.25
|
| Rate for Payer: Quartz Beloit One Network |
$156.20
|
| Rate for Payer: Quartz Commercial |
$202.35
|
| Rate for Payer: The Alliance Commercial |
$177.50
|
| Rate for Payer: United Healthcare Medicaid |
$56.18
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Interrogation Device Evaluation, Remote
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
6243575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$2,156.00 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Aetna Managed Medicare |
$150.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.62
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$350.35
|
| Rate for Payer: Quartz Medicare Advantage |
$323.40
|
| Rate for Payer: The Alliance Commercial |
$2,156.00
|
| Rate for Payer: United Healthcare PPO |
$404.25
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
Interrogation Device Evaluation, Remote
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
6243575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$495.88 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$323.40
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
Interrogation Device Evaluation, Remote
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 93298
|
| Hospital Charge Code |
1190889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.87
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: The Alliance Commercial |
$269.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.35
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Interrogation Device Evaluation, Remote 9329826
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 93298 26
|
| Hospital Charge Code |
6243408
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.87
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.35
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Interrogation Device Single, Dual 9328926
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 93289 26
|
| Hospital Charge Code |
3245519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$337.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$337.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.00
|
| Rate for Payer: Health EOS Commercial |
$323.05
|
| Rate for Payer: HFN Commercial |
$337.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Preferred Network Access Commercial |
$337.25
|
| Rate for Payer: Quartz Beloit One Network |
$156.20
|
| Rate for Payer: Quartz Commercial |
$202.35
|
| Rate for Payer: The Alliance Commercial |
$177.50
|
| Rate for Payer: United Healthcare Medicaid |
$56.18
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
