|
Metalic Biopsy Marker
|
Professional
|
Both
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.48 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.20
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| Rate for Payer: HFN Commercial |
$419.90
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| Rate for Payer: The Alliance Commercial |
$221.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Aetna Managed Medicare |
$16.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.12
|
| Rate for Payer: Anthem Medicaid |
$17.50
|
| Rate for Payer: Anthem Medicare Advantage |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.94
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.11
|
| Rate for Payer: Dean Health Medicaid |
$17.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.94
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.94
|
| Rate for Payer: Managed Health Services Medicaid |
$18.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.94
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.41
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.50
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$16.94
|
| Rate for Payer: The Alliance Commercial |
$67.76
|
| Rate for Payer: United Healthcare Medicaid |
$17.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare PPO |
$246.75
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$16.94
|
| Rate for Payer: WMAP Medicaid |
$17.50
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$312.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$312.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.40
|
| Rate for Payer: Health EOS Commercial |
$299.39
|
| Rate for Payer: HFN Commercial |
$312.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$312.55
|
| Rate for Payer: Quartz Beloit One Network |
$144.76
|
| Rate for Payer: Quartz Commercial |
$187.53
|
| Rate for Payer: The Alliance Commercial |
$164.50
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$197.40
|
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Aetna Managed Medicare |
$16.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.12
|
| Rate for Payer: Anthem Medicaid |
$17.50
|
| Rate for Payer: Anthem Medicare Advantage |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.94
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.31
|
| Rate for Payer: Dean Health Medicaid |
$17.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.94
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.94
|
| Rate for Payer: Managed Health Services Medicaid |
$18.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.94
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.41
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.50
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$210.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16.94
|
| Rate for Payer: The Alliance Commercial |
$67.76
|
| Rate for Payer: United Healthcare Medicaid |
$17.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare PPO |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: Wellcare Medicare |
$16.94
|
| Rate for Payer: WMAP Medicaid |
$17.50
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.40
|
| Rate for Payer: Health EOS Commercial |
$294.84
|
| Rate for Payer: HFN Commercial |
$307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.80
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Preferred Network Access Commercial |
$307.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.56
|
| Rate for Payer: Quartz Commercial |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Metanephrines Fract Rand Urine
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Metanephrines Fract Rand Urine
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$59.80 |
| 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 |
$59.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.80
|
| 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
|
|
|
Metanephrines Fract Rand Urine
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$67.76 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$16.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.12
|
| Rate for Payer: Anthem Medicaid |
$17.50
|
| Rate for Payer: Anthem Medicare Advantage |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.94
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Dean Health Medicaid |
$17.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.94
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.94
|
| Rate for Payer: Managed Health Services Medicaid |
$18.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.94
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.41
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.50
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.94
|
| Rate for Payer: The Alliance Commercial |
$67.76
|
| Rate for Payer: United Healthcare Medicaid |
$17.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.94
|
| Rate for Payer: United Healthcare PPO |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: Wellcare Medicare |
$16.94
|
| Rate for Payer: WMAP Medicaid |
$17.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
METATARSAL BARS MEDIUM
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2970845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
METATARSAL BARS MEDIUM
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2970845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
METATARSAL HEAD RESECTION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
METATARSAL HEAD RESECTION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
Metformin, Blood
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4340650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$186.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.60
|
| Rate for Payer: Health EOS Commercial |
$178.36
|
| Rate for Payer: HFN Commercial |
$186.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$186.20
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$111.72
|
| Rate for Payer: The Alliance Commercial |
$98.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Metformin, Blood
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4340650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Metformin, Blood
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4340650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Methadone Level Serum
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3546215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: HFN Commercial |
$113.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: The Alliance Commercial |
$59.50
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Methadone Level Serum
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3546215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Methadone Level Serum
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
3546215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$71.40
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: United Healthcare PPO |
$89.25
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Methadone Level Urine
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
978016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Methadone Level Urine
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
978016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: United Healthcare PPO |
$117.75
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Methadone Level Urine
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
978016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna Commercial |
$149.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$149.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.20
|
| Rate for Payer: Health EOS Commercial |
$142.87
|
| Rate for Payer: HFN Commercial |
$149.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Preferred Network Access Commercial |
$149.15
|
| Rate for Payer: Quartz Beloit One Network |
$69.08
|
| Rate for Payer: Quartz Commercial |
$89.49
|
| Rate for Payer: The Alliance Commercial |
$78.50
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Methorexate 50 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
2958924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.40
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$6.43
|
|
|
Methorexate 50 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
2958924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
