|
MENDER MENISCUS II 7209485
|
Facility
|
OP
|
$1,824.00
|
|
| Hospital Charge Code |
2965964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.72 |
| Max. Negotiated Rate |
$7,296.00 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Aetna Managed Medicare |
$510.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$912.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.71
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.00
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,094.40
|
| Rate for Payer: The Alliance Commercial |
$7,296.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,902.67 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,329.80
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,471.23 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Aetna Commercial |
$3,688.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,688.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.80
|
| Rate for Payer: Health EOS Commercial |
$3,533.53
|
| Rate for Payer: HFN Commercial |
$3,688.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,471.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,471.23
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,688.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.52
|
| Rate for Payer: Quartz Commercial |
$2,213.31
|
| Rate for Payer: The Alliance Commercial |
$1,941.50
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.78 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$416.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,562.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$729.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.85
|
| Rate for Payer: Anthem Medicaid |
$416.78
|
| Rate for Payer: Anthem Medicare Advantage |
$416.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$416.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$416.78
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$416.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$416.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,172.93
|
| Rate for Payer: Dean Health Medicaid |
$416.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$416.78
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,550.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$416.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$416.78
|
| Rate for Payer: Managed Health Services Medicaid |
$433.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$416.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$416.78
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.17
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$416.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,523.95
|
| Rate for Payer: Quartz Medicare Advantage |
$416.78
|
| Rate for Payer: The Alliance Commercial |
$1,667.12
|
| Rate for Payer: United Healthcare Medicaid |
$416.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.78
|
| Rate for Payer: United Healthcare PPO |
$2,912.25
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: Wellcare Medicare |
$416.78
|
| Rate for Payer: WMAP Medicaid |
$416.78
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
Meningococcal Vaccine, IM 90734
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$1,624.00 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Aetna Managed Medicare |
$113.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.18
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$373.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.20
|
| Rate for Payer: Health EOS Commercial |
$361.34
|
| Rate for Payer: HFN Commercial |
$373.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: NAPHCARE Commercial |
$243.60
|
| Rate for Payer: Preferred Network Access Commercial |
$373.52
|
| Rate for Payer: Quartz Beloit One Network |
$198.94
|
| Rate for Payer: Quartz Commercial |
$263.90
|
| Rate for Payer: Quartz Medicare Advantage |
$243.60
|
| Rate for Payer: The Alliance Commercial |
$1,624.00
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
|
Meningococcal Vaccine, IM 90734
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.49 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Aetna Commercial |
$385.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$385.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.60
|
| Rate for Payer: Health EOS Commercial |
$369.46
|
| Rate for Payer: HFN Commercial |
$385.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.10
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Preferred Network Access Commercial |
$385.70
|
| Rate for Payer: Quartz Beloit One Network |
$178.64
|
| Rate for Payer: Quartz Commercial |
$231.42
|
| Rate for Payer: The Alliance Commercial |
$203.00
|
| Rate for Payer: United Healthcare Medicaid |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
|
Meningococcal Vaccine, IM 90734
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$373.52 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.18
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$373.52
|
| Rate for Payer: Health EOS Commercial |
$361.34
|
| Rate for Payer: HFN Commercial |
$373.52
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: NAPHCARE Commercial |
$243.60
|
| Rate for Payer: Preferred Network Access Commercial |
$373.52
|
| Rate for Payer: Quartz Beloit One Network |
$198.94
|
| Rate for Payer: Quartz Commercial |
$243.60
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
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: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.66
|
| 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 |
$15.43
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
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
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$224.10 |
| 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 |
$163.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.10
|
| 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 |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Meningococcal Vaccine, SC 90733
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.49 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$350.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$350.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.40
|
| Rate for Payer: Health EOS Commercial |
$335.79
|
| Rate for Payer: HFN Commercial |
$350.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.57
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: Preferred Network Access Commercial |
$350.55
|
| Rate for Payer: Quartz Beloit One Network |
$162.36
|
| Rate for Payer: Quartz Commercial |
$210.33
|
| Rate for Payer: The Alliance Commercial |
$184.50
|
| Rate for Payer: United Healthcare Medicaid |
$121.49
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
Meningococcal Vaccine, SC 90733
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.81 |
| Max. Negotiated Rate |
$339.48 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$221.40
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
Meningococcal Vaccine, SC 90733
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.32 |
| Max. Negotiated Rate |
$1,476.00 |
| Rate for Payer: Aetna Commercial |
$332.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.34
|
| Rate for Payer: Aetna Managed Medicare |
$103.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.57
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$339.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.49
|
| Rate for Payer: Health EOS Commercial |
$328.41
|
| Rate for Payer: HFN Commercial |
$339.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.75
|
| Rate for Payer: Multiplan Commercial |
$295.20
|
| Rate for Payer: NAPHCARE Commercial |
$221.40
|
| Rate for Payer: Preferred Network Access Commercial |
$339.48
|
| Rate for Payer: Quartz Beloit One Network |
$180.81
|
| Rate for Payer: Quartz Commercial |
$239.85
|
| Rate for Payer: Quartz Medicare Advantage |
$221.40
|
| Rate for Payer: The Alliance Commercial |
$1,476.00
|
| Rate for Payer: WEA Trust Commercial |
$202.95
|
| Rate for Payer: WPS Commercial |
$273.32
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
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: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.66
|
| 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 |
$15.43
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$215.57 |
| 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 |
$121.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.57
|
| 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 |
$121.49
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
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
|
|
|
MENISCAL CINCH AR-4500
|
Facility
|
OP
|
$5,358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.24 |
| Max. Negotiated Rate |
$21,432.00 |
| Rate for Payer: Aetna Commercial |
$4,822.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,607.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,500.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,482.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,571.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,839.74
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$4,929.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,998.34
|
| Rate for Payer: Health EOS Commercial |
$4,768.62
|
| Rate for Payer: HFN Commercial |
$4,929.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,018.50
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,929.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.42
|
| Rate for Payer: Quartz Commercial |
$3,482.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,214.80
|
| Rate for Payer: The Alliance Commercial |
$21,432.00
|
| Rate for Payer: WEA Trust Commercial |
$2,946.90
|
| Rate for Payer: WPS Commercial |
$3,968.67
|
|
|
MENISCAL CINCH AR-4500
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.42 |
| Max. Negotiated Rate |
$4,929.36 |
| Rate for Payer: Aetna Commercial |
$4,822.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,607.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,839.74
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$4,929.36
|
| Rate for Payer: Health EOS Commercial |
$4,768.62
|
| Rate for Payer: HFN Commercial |
$4,929.36
|
| Rate for Payer: Multiplan Commercial |
$4,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,929.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.42
|
| Rate for Payer: Quartz Commercial |
$3,214.80
|
| Rate for Payer: WEA Trust Commercial |
$2,946.90
|
| Rate for Payer: WPS Commercial |
$3,968.67
|
|
|
MENISCAL CINCH SPEEDCINCH AR-4501
|
Facility
|
IP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,450.98 |
| Max. Negotiated Rate |
$4,601.84 |
| Rate for Payer: Aetna Commercial |
$4,501.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,301.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.06
|
| Rate for Payer: Cash Price |
$1,500.60
|
| Rate for Payer: Cigna Commercial |
$4,601.84
|
| Rate for Payer: Health EOS Commercial |
$4,451.78
|
| Rate for Payer: HFN Commercial |
$4,601.84
|
| Rate for Payer: Multiplan Commercial |
$4,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,001.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,601.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,450.98
|
| Rate for Payer: Quartz Commercial |
$3,001.20
|
| Rate for Payer: WEA Trust Commercial |
$2,751.10
|
| Rate for Payer: WPS Commercial |
$3,704.98
|
|
|
MENISCAL CINCH SPEEDCINCH AR-4501
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.56 |
| Max. Negotiated Rate |
$20,008.00 |
| Rate for Payer: Aetna Commercial |
$4,501.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,301.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,400.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,251.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,501.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,400.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.06
|
| Rate for Payer: Cash Price |
$1,500.60
|
| Rate for Payer: Cigna Commercial |
$4,601.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,799.12
|
| Rate for Payer: Health EOS Commercial |
$4,451.78
|
| Rate for Payer: HFN Commercial |
$4,601.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,751.50
|
| Rate for Payer: Multiplan Commercial |
$4,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,001.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,601.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,450.98
|
| Rate for Payer: Quartz Commercial |
$3,251.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,001.20
|
| Rate for Payer: The Alliance Commercial |
$20,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,751.10
|
| Rate for Payer: WPS Commercial |
$3,704.98
|
|
|
MENISCECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
MENISCECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$26,784.00
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$9,634.57 |
| Max. Negotiated Rate |
$26,784.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,634.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,634.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,634.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,634.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,634.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,959.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,634.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,410.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,634.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,634.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,634.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,634.57
|
| Rate for Payer: NAPHCARE Commercial |
$14,451.86
|
| Rate for Payer: Quartz Medicare Advantage |
$9,634.57
|
| Rate for Payer: The Alliance Commercial |
$26,784.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,634.57
|
| Rate for Payer: United Healthcare PPO |
$15,111.17
|
| Rate for Payer: Wellcare Medicare |
$9,634.57
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,421.00
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$5,906.80 |
| Max. Negotiated Rate |
$16,421.00 |
| Rate for Payer: Wellcare Medicare |
$5,906.80
|
| Rate for Payer: Aetna Managed Medicare |
$5,906.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,797.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,809.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,319.58
|
| Rate for Payer: Anthem Medicare Advantage |
$5,906.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,906.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,906.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,906.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,345.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,906.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,809.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,906.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,906.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,906.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,906.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,860.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,906.80
|
| Rate for Payer: The Alliance Commercial |
$16,421.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,906.80
|
| Rate for Payer: United Healthcare PPO |
$9,193.61
|
|
|
Menveo Vaccine 90734
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5577560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.49 |
| Max. Negotiated Rate |
$385.70 |
| Rate for Payer: Aetna Commercial |
$385.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$385.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.60
|
| Rate for Payer: Health EOS Commercial |
$369.46
|
| Rate for Payer: HFN Commercial |
$385.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.10
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Preferred Network Access Commercial |
$385.70
|
| Rate for Payer: Quartz Beloit One Network |
$178.64
|
| Rate for Payer: Quartz Commercial |
$231.42
|
| Rate for Payer: The Alliance Commercial |
$203.00
|
| Rate for Payer: United Healthcare Medicaid |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
