|
Methylprednisolone Inj <125 mg J2930
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3921375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.45
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Metoclopramide hcl Inj up to 10 Mg J2765
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
3508180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Metoclopramide hcl Inj up to 10 Mg J2765
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
3508180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.38
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$2.60
|
|
|
Metoclopramide hcl Inj up to 10 Mg J2765
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
3508180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.04
|
| Rate for Payer: Health EOS Commercial |
$0.91
|
| Rate for Payer: HFN Commercial |
$0.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.65
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Preferred Network Access Commercial |
$0.95
|
| Rate for Payer: Quartz Beloit One Network |
$0.44
|
| Rate for Payer: Quartz Commercial |
$0.57
|
| Rate for Payer: The Alliance Commercial |
$0.50
|
| Rate for Payer: United Healthcare Medicaid |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$2.60
|
|
|
Metoprolol Level
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| 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 |
$94.87
|
| 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 |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| 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 |
$100.17
|
| 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 |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| 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 |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| 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 |
$134.25
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Metoprolol Level
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Metoprolol Level
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5364647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna Commercial |
$170.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$170.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.40
|
| Rate for Payer: Health EOS Commercial |
$162.89
|
| Rate for Payer: HFN Commercial |
$170.05
|
| 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 |
$143.20
|
| Rate for Payer: Preferred Network Access Commercial |
$170.05
|
| Rate for Payer: Quartz Beloit One Network |
$78.76
|
| Rate for Payer: Quartz Commercial |
$102.03
|
| Rate for Payer: The Alliance Commercial |
$89.50
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
MI 2 Autoabs
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
MI 2 Autoabs
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
MI 2 Autoabs
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
MIC-KEY LOW PROFILE GASTRO 20FR 4.0 FEEDING TUBE
|
Facility
|
OP
|
$1,943.00
|
|
| Hospital Charge Code |
2972779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$544.04 |
| Max. Negotiated Rate |
$7,772.00 |
| Rate for Payer: Aetna Commercial |
$1,748.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,670.98
|
| Rate for Payer: Aetna Managed Medicare |
$544.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$971.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.79
|
| Rate for Payer: Cash Price |
$582.90
|
| Rate for Payer: Cigna Commercial |
$1,787.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,087.30
|
| Rate for Payer: Health EOS Commercial |
$1,729.27
|
| Rate for Payer: HFN Commercial |
$1,787.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,457.25
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,787.56
|
| Rate for Payer: Quartz Beloit One Network |
$952.07
|
| Rate for Payer: Quartz Commercial |
$1,262.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.80
|
| Rate for Payer: The Alliance Commercial |
$7,772.00
|
| Rate for Payer: WEA Trust Commercial |
$1,068.65
|
| Rate for Payer: WPS Commercial |
$1,439.18
|
|
|
MIC-KEY LOW PROFILE GASTRO 20FR 4.0 FEEDING TUBE
|
Facility
|
IP
|
$1,943.00
|
|
| Hospital Charge Code |
2972779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$952.07 |
| Max. Negotiated Rate |
$1,787.56 |
| Rate for Payer: Aetna Commercial |
$1,748.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,670.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.79
|
| Rate for Payer: Cash Price |
$582.90
|
| Rate for Payer: Cigna Commercial |
$1,787.56
|
| Rate for Payer: Health EOS Commercial |
$1,729.27
|
| Rate for Payer: HFN Commercial |
$1,787.56
|
| Rate for Payer: Multiplan Commercial |
$1,554.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,787.56
|
| Rate for Payer: Quartz Beloit One Network |
$952.07
|
| Rate for Payer: Quartz Commercial |
$1,165.80
|
| Rate for Payer: WEA Trust Commercial |
$1,068.65
|
| Rate for Payer: WPS Commercial |
$1,439.18
|
|
|
MIC-KEY LOW PROFILE GASTRO 20FR 5.0 FEEDING TUBE
|
Facility
|
OP
|
$1,853.00
|
|
| Hospital Charge Code |
2972738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$7,412.00 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,036.94
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$7,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
MIC-KEY LOW PROFILE GASTRO 20FR 5.0 FEEDING TUBE
|
Facility
|
IP
|
$1,853.00
|
|
| Hospital Charge Code |
2972738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$907.97 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,111.80
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
Microalbumin, 24hr Urine w/creat
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4619090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.40
|
| Rate for Payer: Health EOS Commercial |
$3.64
|
| Rate for Payer: HFN Commercial |
$3.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3.80
|
| Rate for Payer: Quartz Beloit One Network |
$1.76
|
| Rate for Payer: Quartz Commercial |
$2.28
|
| Rate for Payer: The Alliance Commercial |
$2.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Microalbumin, 24hr Urine w/creat
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4619090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Microalbumin, 24hr Urine w/creat
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
4619090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$23.12 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Dean Health Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Microdrip Tubing - Peripheral IV Equipment:
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
3788280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Microdrip Tubing - Peripheral IV Equipment:
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
3788280
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
MICRO-INTRODUCER MICRO ACCESS 5FR X 10CM STANDARD 06597102
|
Facility
|
IP
|
$484.00
|
|
| Hospital Charge Code |
2963004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
MICRO-INTRODUCER MICRO ACCESS 5FR X 10CM STANDARD 06597102
|
Facility
|
OP
|
$484.00
|
|
| Hospital Charge Code |
2963004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 11CM MIS-7F11
|
Facility
|
IP
|
$626.00
|
|
| Hospital Charge Code |
4069311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 11CM MIS-7F11
|
Facility
|
OP
|
$626.00
|
|
| Hospital Charge Code |
4069311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 7CM MIS-7F07
|
Facility
|
OP
|
$651.00
|
|
| Hospital Charge Code |
5248717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.28 |
| Max. Negotiated Rate |
$2,604.00 |
| Rate for Payer: Aetna Commercial |
$585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Aetna Managed Medicare |
$182.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.03
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$598.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.30
|
| Rate for Payer: Health EOS Commercial |
$579.39
|
| Rate for Payer: HFN Commercial |
$598.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.25
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: NAPHCARE Commercial |
$390.60
|
| Rate for Payer: Preferred Network Access Commercial |
$598.92
|
| Rate for Payer: Quartz Beloit One Network |
$318.99
|
| Rate for Payer: Quartz Commercial |
$423.15
|
| Rate for Payer: Quartz Medicare Advantage |
$390.60
|
| Rate for Payer: The Alliance Commercial |
$2,604.00
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
|
MICRO INTRODUCER SHEATH SET 7FR 7CM MIS-7F07
|
Facility
|
IP
|
$651.00
|
|
| Hospital Charge Code |
5248717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$598.92 |
| Rate for Payer: Aetna Commercial |
$585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.03
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$598.92
|
| Rate for Payer: Health EOS Commercial |
$579.39
|
| Rate for Payer: HFN Commercial |
$598.92
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: NAPHCARE Commercial |
$390.60
|
| Rate for Payer: Preferred Network Access Commercial |
$598.92
|
| Rate for Payer: Quartz Beloit One Network |
$318.99
|
| Rate for Payer: Quartz Commercial |
$390.60
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
