|
Interleukin 1 Beta
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$288.60
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Interleukin 1 Beta
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Interleukin 1 Beta
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Aetna Commercial |
$365.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$365.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$350.17
|
| Rate for Payer: HFN Commercial |
$365.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$365.56
|
| Rate for Payer: Quartz Beloit One Network |
$169.31
|
| Rate for Payer: Quartz Commercial |
$219.34
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Interleukin 6 High Sensitive, ELISA
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$198.43
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
Interleukin 6 High Sensitive, ELISA
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$314.18 |
| Rate for Payer: Aetna Commercial |
$314.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$314.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$300.96
|
| Rate for Payer: HFN Commercial |
$314.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$314.18
|
| Rate for Payer: Quartz Beloit One Network |
$145.52
|
| Rate for Payer: Quartz Commercial |
$188.51
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Interleukin 6 High Sensitive, ELISA
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$214.97
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$248.04
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
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 |
$173.72 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
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 |
$31.11 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$31.11
|
| Rate for Payer: Anthem Medicare Advantage |
$31.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.11
|
| 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 |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.11
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.11
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$46.66
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$31.11
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare Medicaid |
$51.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.11
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$139.98
|
|
|
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 |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Intermediate Observation Per Hour
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040436
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Intermediate Observation Per Hour
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040436
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$7,271.68 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,271.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,958.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.74
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$51.79
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$51.79
|
| Rate for Payer: The Alliance Commercial |
$43.16
|
| Rate for Payer: United Healthcare PPO |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
INTERMEDIATE WOUND REPAIR AND TREATMENT
|
Facility
|
OP
|
$84.46
|
|
|
Service Code
|
EAPG 00017
|
| Min. Negotiated Rate |
$81.21 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Anthem Medicaid |
$81.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$81.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.21
|
| Rate for Payer: Dean Health Medicaid |
$81.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$81.21
|
| Rate for Payer: Managed Health Services Medicaid |
$84.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$81.21
|
| Rate for Payer: United Healthcare Medicaid |
$81.21
|
|
|
Intermittent Self Cath
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$206.54
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Intermittent Self Cath
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Aetna Managed Medicare |
$96.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.64
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.18
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: NAPHCARE Commercial |
$206.54
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$223.76
|
| Rate for Payer: Quartz Medicare Advantage |
$206.54
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Interp & Report
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Interp & Report
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.92
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$71.14
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Interp & Report
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2776821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.14
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
INTERPULSE HANDPIECE NO TIP 210-100
|
Facility
|
IP
|
$703.00
|
|
| Hospital Charge Code |
2963643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.25 |
| Max. Negotiated Rate |
$672.63 |
| Rate for Payer: Aetna Commercial |
$658.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.49
|
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Cigna Commercial |
$672.63
|
| Rate for Payer: Health EOS Commercial |
$650.70
|
| Rate for Payer: HFN Commercial |
$672.63
|
| Rate for Payer: Multiplan Commercial |
$584.90
|
| Rate for Payer: Preferred Network Access Commercial |
$672.63
|
| Rate for Payer: Quartz Beloit One Network |
$358.25
|
| Rate for Payer: Quartz Commercial |
$438.67
|
| Rate for Payer: WEA Trust Commercial |
$402.12
|
| Rate for Payer: WPS Commercial |
$541.52
|
|
|
INTERPULSE HANDPIECE NO TIP 210-100
|
Facility
|
OP
|
$703.00
|
|
| Hospital Charge Code |
2963643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.71 |
| Max. Negotiated Rate |
$672.63 |
| Rate for Payer: Aetna Commercial |
$658.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.76
|
| Rate for Payer: Aetna Managed Medicare |
$204.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.49
|
| Rate for Payer: Cash Price |
$210.90
|
| Rate for Payer: Cigna Commercial |
$672.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.15
|
| Rate for Payer: Health EOS Commercial |
$650.70
|
| Rate for Payer: HFN Commercial |
$672.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.34
|
| Rate for Payer: Multiplan Commercial |
$584.90
|
| Rate for Payer: NAPHCARE Commercial |
$438.67
|
| Rate for Payer: Preferred Network Access Commercial |
$672.63
|
| Rate for Payer: Quartz Beloit One Network |
$358.25
|
| Rate for Payer: Quartz Commercial |
$475.23
|
| Rate for Payer: Quartz Medicare Advantage |
$438.67
|
| Rate for Payer: The Alliance Commercial |
$365.56
|
| Rate for Payer: WEA Trust Commercial |
$402.12
|
| Rate for Payer: WPS Commercial |
$541.52
|
|
|
INTERPULSE LAVAGE W/TIP SOFT TISSUE 210-118-200
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
5264677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.85
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.50
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
INTERPULSE LAVAGE W/TIP SOFT TISSUE 210-118-200
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
5264677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
INTERPULSE PULSAVAC BONE 0210-110-000
|
Facility
|
OP
|
$1,022.00
|
|
| Hospital Charge Code |
2963041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.61 |
| Max. Negotiated Rate |
$977.85 |
| Rate for Payer: Aetna Commercial |
$956.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Aetna Managed Medicare |
$297.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.33
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$977.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.80
|
| Rate for Payer: Health EOS Commercial |
$945.96
|
| Rate for Payer: HFN Commercial |
$977.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.16
|
| Rate for Payer: Multiplan Commercial |
$850.30
|
| Rate for Payer: NAPHCARE Commercial |
$637.73
|
| Rate for Payer: Preferred Network Access Commercial |
$977.85
|
| Rate for Payer: Quartz Beloit One Network |
$520.81
|
| Rate for Payer: Quartz Commercial |
$690.87
|
| Rate for Payer: Quartz Medicare Advantage |
$637.73
|
| Rate for Payer: The Alliance Commercial |
$531.44
|
| Rate for Payer: WEA Trust Commercial |
$584.58
|
| Rate for Payer: WPS Commercial |
$787.25
|
|
|
INTERPULSE PULSAVAC BONE 0210-110-000
|
Facility
|
IP
|
$1,022.00
|
|
| Hospital Charge Code |
2963041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.81 |
| Max. Negotiated Rate |
$977.85 |
| Rate for Payer: Aetna Commercial |
$956.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.33
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$977.85
|
| Rate for Payer: Health EOS Commercial |
$945.96
|
| Rate for Payer: HFN Commercial |
$977.85
|
| Rate for Payer: Multiplan Commercial |
$850.30
|
| Rate for Payer: Preferred Network Access Commercial |
$977.85
|
| Rate for Payer: Quartz Beloit One Network |
$520.81
|
| Rate for Payer: Quartz Commercial |
$637.73
|
| Rate for Payer: WEA Trust Commercial |
$584.58
|
| Rate for Payer: WPS Commercial |
$787.25
|
|
|
Interrogation Device Eval 93288
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
3354934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$770.64 |
| Rate for Payer: Aetna Commercial |
$770.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$55.40
|
| Rate for Payer: Anthem Medicare Advantage |
$55.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.40
|
| 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 |
$770.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.40
|
| Rate for Payer: Health EOS Commercial |
$738.19
|
| Rate for Payer: HFN Commercial |
$770.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$194.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.40
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$83.10
|
| Rate for Payer: Preferred Network Access Commercial |
$770.64
|
| Rate for Payer: Quartz Beloit One Network |
$356.93
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$55.40
|
| Rate for Payer: The Alliance Commercial |
$210.52
|
| Rate for Payer: United Healthcare Medicaid |
$33.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.40
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$221.60
|
|
|
Interrogation Device Eval 9328826
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 93288 26
|
| Hospital Charge Code |
3137563
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$770.64 |
| Rate for Payer: Aetna Commercial |
$770.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$20.35
|
| Rate for Payer: Anthem Medicare Advantage |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.35
|
| 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 |
$770.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.35
|
| Rate for Payer: Health EOS Commercial |
$738.19
|
| Rate for Payer: HFN Commercial |
$770.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.35
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$30.53
|
| Rate for Payer: Preferred Network Access Commercial |
$770.64
|
| Rate for Payer: Quartz Beloit One Network |
$356.93
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$20.35
|
| Rate for Payer: The Alliance Commercial |
$77.34
|
| Rate for Payer: United Healthcare Medicaid |
$19.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.35
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$81.41
|
|
