|
MEASUREMENT WIRE 1.1MM CALIBRATED AR-9938-04
|
Facility
|
IP
|
$2,291.55
|
|
| Hospital Charge Code |
6252128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,167.77 |
| Max. Negotiated Rate |
$2,192.56 |
| Rate for Payer: Aetna Commercial |
$2,144.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.10
|
| Rate for Payer: Cash Price |
$687.46
|
| Rate for Payer: Cigna Commercial |
$2,192.56
|
| Rate for Payer: Health EOS Commercial |
$2,121.06
|
| Rate for Payer: HFN Commercial |
$2,192.56
|
| Rate for Payer: Multiplan Commercial |
$1,906.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.77
|
| Rate for Payer: Quartz Commercial |
$1,429.93
|
| Rate for Payer: WEA Trust Commercial |
$1,310.77
|
| Rate for Payer: WPS Commercial |
$1,765.18
|
|
|
MEASUREMENT WIRE 1.1MM CALIBRATED AR-9938-04
|
Facility
|
OP
|
$2,291.55
|
|
| Hospital Charge Code |
6252128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$667.30 |
| Max. Negotiated Rate |
$2,192.56 |
| Rate for Payer: Aetna Commercial |
$2,144.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.56
|
| Rate for Payer: Aetna Managed Medicare |
$667.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,549.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,191.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,143.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.10
|
| Rate for Payer: Cash Price |
$687.46
|
| Rate for Payer: Cigna Commercial |
$2,192.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,333.68
|
| Rate for Payer: Health EOS Commercial |
$2,121.06
|
| Rate for Payer: HFN Commercial |
$2,192.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,787.41
|
| Rate for Payer: Multiplan Commercial |
$1,906.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,429.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.77
|
| Rate for Payer: Quartz Commercial |
$1,549.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,429.93
|
| Rate for Payer: The Alliance Commercial |
$1,191.61
|
| Rate for Payer: WEA Trust Commercial |
$1,310.77
|
| Rate for Payer: WPS Commercial |
$1,765.18
|
|
|
MEATOPLASTY/MEATOTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
MEATOPLASTY/MEATOTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Mechanical percussion
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989713
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Mechanical percussion
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989713
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
MEDIASTINAL TUMOR RESECTION AND BIOPSY
|
Facility
|
OP
|
$8,375.00
|
|
| Hospital Charge Code |
2960348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,438.80 |
| Max. Negotiated Rate |
$8,013.20 |
| Rate for Payer: Aetna Commercial |
$7,839.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,490.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,438.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,661.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,180.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,616.30
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$8,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,874.25
|
| Rate for Payer: Health EOS Commercial |
$7,751.90
|
| Rate for Payer: HFN Commercial |
$8,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,532.50
|
| Rate for Payer: Multiplan Commercial |
$6,968.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,226.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,013.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,267.90
|
| Rate for Payer: Quartz Commercial |
$5,661.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,226.00
|
| Rate for Payer: The Alliance Commercial |
$4,355.00
|
| Rate for Payer: WEA Trust Commercial |
$4,790.50
|
| Rate for Payer: WPS Commercial |
$6,451.26
|
|
|
MEDIASTINAL TUMOR RESECTION AND BIOPSY
|
Facility
|
IP
|
$8,375.00
|
|
| Hospital Charge Code |
2960348
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.90 |
| Max. Negotiated Rate |
$8,013.20 |
| Rate for Payer: Aetna Commercial |
$7,839.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,490.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,616.30
|
| Rate for Payer: Cash Price |
$2,512.50
|
| Rate for Payer: Cigna Commercial |
$8,013.20
|
| Rate for Payer: Health EOS Commercial |
$7,751.90
|
| Rate for Payer: HFN Commercial |
$8,013.20
|
| Rate for Payer: Multiplan Commercial |
$6,968.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,013.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,267.90
|
| Rate for Payer: Quartz Commercial |
$5,226.00
|
| Rate for Payer: WEA Trust Commercial |
$4,790.50
|
| Rate for Payer: WPS Commercial |
$6,451.26
|
|
|
MEDIASTINOSCOPY
|
Facility
|
IP
|
$4,923.00
|
|
| Hospital Charge Code |
2960229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,508.76 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,071.95
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
MEDIASTINOSCOPY
|
Facility
|
OP
|
$4,923.00
|
|
| Hospital Charge Code |
2960229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.58 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,327.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,559.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,457.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.19
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,839.94
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,071.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,327.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,071.95
|
| Rate for Payer: The Alliance Commercial |
$2,559.96
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Aetna Managed Medicare |
$6.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.73
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: NAPHCARE Commercial |
$13.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$14.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.00
|
| Rate for Payer: The Alliance Commercial |
$7.58
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$54.28
|
|
|
Medicaid Fluzone (0.50 ml dose) 90688VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
5100628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$20.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.71
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.11
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$20.58
|
| Rate for Payer: Quartz Beloit One Network |
$9.53
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$54.28
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$47,389.68
|
|
|
Service Code
|
MSDRG 551
|
| Min. Negotiated Rate |
$13,342.69 |
| Max. Negotiated Rate |
$47,389.68 |
| Rate for Payer: Aetna Managed Medicare |
$13,342.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,571.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,031.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,631.75
|
| Rate for Payer: Anthem Medicare Advantage |
$13,342.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,342.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,342.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,342.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,563.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,342.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,514.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,342.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,342.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,342.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,342.69
|
| Rate for Payer: NAPHCARE Commercial |
$20,014.04
|
| Rate for Payer: Quartz Medicare Advantage |
$13,342.69
|
| Rate for Payer: The Alliance Commercial |
$47,389.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,342.69
|
| Rate for Payer: United Healthcare PPO |
$26,870.00
|
| Rate for Payer: Wellcare Medicare |
$13,342.69
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$27,050.40
|
|
|
Service Code
|
MSDRG 552
|
| Min. Negotiated Rate |
$7,868.61 |
| Max. Negotiated Rate |
$27,050.40 |
| Rate for Payer: Aetna Managed Medicare |
$7,868.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,974.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,077.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,274.21
|
| Rate for Payer: Anthem Medicare Advantage |
$7,868.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,868.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,868.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,868.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,955.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,868.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,596.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,868.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,868.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,868.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,868.61
|
| Rate for Payer: NAPHCARE Commercial |
$11,802.91
|
| Rate for Payer: Quartz Medicare Advantage |
$7,868.61
|
| Rate for Payer: The Alliance Commercial |
$27,050.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,868.61
|
| Rate for Payer: United Healthcare PPO |
$15,256.18
|
| Rate for Payer: Wellcare Medicare |
$7,868.61
|
|
|
Medical Nutrition, Indiv, IN 97802
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
3748947
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$116.93 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.83
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.83
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.25
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$26.83
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$107.33
|
|
|
Medical Nutrition Therapy Grp2/Indiv ea 30 min
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
5322669
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$49.80
|
| Rate for Payer: United Healthcare PPO |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Medical Nutrition Therapy Grp2/Indiv ea 30 min
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
5322669
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Min
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
4616797
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Min
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
4616797
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$107.33
|
| Rate for Payer: United Healthcare PPO |
$75.66
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Medical Nutrition Therapy, Initial Individual Each 15 Minutes
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
2957671
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$116.93 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.83
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.83
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.25
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$26.83
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$107.33
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Min
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
4616796
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$89.56
|
| Rate for Payer: United Healthcare PPO |
$75.66
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Min
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
4616796
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Medical Nutrition Therapy, Re-Assessment Individual Each 15 Minutes
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
2957672
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.39 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$22.39
|
| Rate for Payer: Anthem Medicare Advantage |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.39
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.39
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$33.59
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$22.39
|
| Rate for Payer: The Alliance Commercial |
$55.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.39
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$89.56
|
|
|
Medicare Administration G0008
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
5470737
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$49.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.28
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.28
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.28
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$73.91
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$49.28
|
| Rate for Payer: The Alliance Commercial |
$197.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.28
|
| Rate for Payer: United Healthcare PPO |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$49.28
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
