|
MEASUREMENT WIRE 1.1MM CALIBRATED AR-9938-04
|
Facility
|
IP
|
$2,291.55
|
|
| Hospital Charge Code |
6252128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,122.86 |
| Max. Negotiated Rate |
$2,108.23 |
| Rate for Payer: Aetna Commercial |
$2,062.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,970.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.52
|
| Rate for Payer: Cash Price |
$687.46
|
| Rate for Payer: Cigna Commercial |
$2,108.23
|
| Rate for Payer: Health EOS Commercial |
$2,039.48
|
| Rate for Payer: HFN Commercial |
$2,108.23
|
| Rate for Payer: Multiplan Commercial |
$1,833.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,108.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.86
|
| Rate for Payer: Quartz Commercial |
$1,374.93
|
| Rate for Payer: WEA Trust Commercial |
$1,260.35
|
| Rate for Payer: WPS Commercial |
$1,697.35
|
|
|
MEATOPLASTY/MEATOTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
MEATOPLASTY/MEATOTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Mechanical percussion
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989713
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Mechanical percussion
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989713
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
MEDIASTINAL TUMOR RESECTION AND BIOPSY
|
Facility
|
IP
|
$8,375.00
|
|
| Hospital Charge Code |
2960348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.75 |
| Max. Negotiated Rate |
$7,705.00 |
| Rate for Payer: Aetna Commercial |
$7,537.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,438.75
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$7,705.00
|
| Rate for Payer: Health EOS Commercial |
$7,453.75
|
| Rate for Payer: HFN Commercial |
$7,705.00
|
| Rate for Payer: Multiplan Commercial |
$6,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,025.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,705.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,103.75
|
| Rate for Payer: Quartz Commercial |
$5,025.00
|
| Rate for Payer: WEA Trust Commercial |
$4,606.25
|
| Rate for Payer: WPS Commercial |
$6,203.36
|
|
|
MEDIASTINAL TUMOR RESECTION AND BIOPSY
|
Facility
|
OP
|
$8,375.00
|
|
| Hospital Charge Code |
2960348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.00 |
| Max. Negotiated Rate |
$33,500.00 |
| Rate for Payer: Aetna Commercial |
$7,537.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,202.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,345.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,443.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,187.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,438.75
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$7,705.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,686.65
|
| Rate for Payer: Health EOS Commercial |
$7,453.75
|
| Rate for Payer: HFN Commercial |
$7,705.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,281.25
|
| Rate for Payer: Multiplan Commercial |
$6,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,025.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,705.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,103.75
|
| Rate for Payer: Quartz Commercial |
$5,443.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,025.00
|
| Rate for Payer: The Alliance Commercial |
$33,500.00
|
| Rate for Payer: WEA Trust Commercial |
$4,606.25
|
| Rate for Payer: WPS Commercial |
$6,203.36
|
|
|
MEDIASTINOSCOPY
|
Facility
|
OP
|
$4,923.00
|
|
| Hospital Charge Code |
2960229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$19,692.00 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: The Alliance Commercial |
$19,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
MEDIASTINOSCOPY
|
Facility
|
IP
|
$4,923.00
|
|
| Hospital Charge Code |
2960229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$83.32 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.62
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.62
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$13.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.50
|
| Rate for Payer: The Alliance Commercial |
$83.32
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$52.20
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.88
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.99
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$52.20
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$45,567.00
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$16,391.04 |
| Max. Negotiated Rate |
$45,567.00 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,831.97
|
| Rate for Payer: Aetna Managed Medicare |
$16,391.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,666.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,337.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,972.60
|
| Rate for Payer: Anthem Medicare Advantage |
$16,391.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,391.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,391.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,391.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,391.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,187.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,391.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,391.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,391.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,391.04
|
| Rate for Payer: NAPHCARE Commercial |
$24,586.56
|
| Rate for Payer: Quartz Medicare Advantage |
$16,391.04
|
| Rate for Payer: The Alliance Commercial |
$45,567.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,391.04
|
| Rate for Payer: United Healthcare PPO |
$25,836.54
|
| Rate for Payer: Wellcare Medicare |
$16,391.04
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$26,010.00
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$9,356.28 |
| Max. Negotiated Rate |
$26,010.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,356.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,350.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,598.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,819.66
|
| Rate for Payer: Anthem Medicare Advantage |
$9,356.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,356.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,356.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,356.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,451.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,356.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,842.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,356.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,356.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,356.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,356.28
|
| Rate for Payer: NAPHCARE Commercial |
$14,034.42
|
| Rate for Payer: Quartz Medicare Advantage |
$9,356.28
|
| Rate for Payer: The Alliance Commercial |
$26,010.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,356.28
|
| Rate for Payer: United Healthcare PPO |
$14,669.40
|
| Rate for Payer: Wellcare Medicare |
$9,356.28
|
|
|
Medical Nutrition, Indiv, IN 97802
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
3748947
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$112.43 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.00
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.43
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Medical Nutrition Therapy Grp2/Indiv ea 30 min
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
5322669
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Medical Nutrition Therapy Grp2/Indiv ea 30 min
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
5322669
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Min
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
4616797
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Min
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
4616797
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Minutes
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
2957671
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$112.43 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.00
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.43
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Min
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
4616796
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Min
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
4616796
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Minutes
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
2957672
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$95.59 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.00
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.59
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Medicare Administration G0008
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
5470737
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$57.26 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.20
|
| Rate for Payer: Health EOS Commercial |
$10.92
|
| Rate for Payer: HFN Commercial |
$11.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.26
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11.40
|
| Rate for Payer: Quartz Beloit One Network |
$5.28
|
| Rate for Payer: Quartz Commercial |
$6.84
|
| Rate for Payer: The Alliance Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Medicare Administration G0008
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
5470737
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
