|
Medroxyprogesterone 150 mg Charge
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
2983537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
MENDER MENISCUS II 7209485
|
Facility
|
IP
|
$1,824.00
|
|
| Hospital Charge Code |
2965964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.51 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,138.18
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
MENDER MENISCUS II 7209485
|
Facility
|
OP
|
$1,824.00
|
|
| Hospital Charge Code |
2965964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.15 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$531.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$948.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,061.57
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.72
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,233.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.18
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$433.45 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$433.45
|
| Rate for Payer: Anthem Medicare Advantage |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$433.45
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.45
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,530.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,530.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$433.45
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$650.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$433.45
|
| Rate for Payer: The Alliance Commercial |
$1,712.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$433.45
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$1,907.19
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
Meningitis Encephalitis PCR to Mercy
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
5296694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$433.45 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$433.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,625.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.53
|
| Rate for Payer: Anthem Medicare Advantage |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$433.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$433.45
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$433.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$433.45
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,612.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$433.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$433.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$433.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$433.45
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$650.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| Rate for Payer: Quartz Medicare Advantage |
$433.45
|
| Rate for Payer: The Alliance Commercial |
$1,733.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$433.45
|
| Rate for Payer: United Healthcare PPO |
$3,028.74
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: Wellcare Medicare |
$433.45
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
Meningococcal Vaccine, IM 90734
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Meningococcal Vaccine, IM 90734
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$118.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.29
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.68
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$253.34
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$274.46
|
| Rate for Payer: Quartz Medicare Advantage |
$253.34
|
| Rate for Payer: The Alliance Commercial |
$211.12
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Meningococcal Vaccine, IM 90734
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
3382907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.42 |
| Max. Negotiated Rate |
$401.13 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$401.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.34
|
| Rate for Payer: Health EOS Commercial |
$384.24
|
| Rate for Payer: HFN Commercial |
$401.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.06
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$401.13
|
| Rate for Payer: Quartz Beloit One Network |
$185.79
|
| Rate for Payer: Quartz Commercial |
$240.68
|
| Rate for Payer: The Alliance Commercial |
$211.12
|
| Rate for Payer: United Healthcare Medicaid |
$173.42
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$19.93 |
| 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: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.12
|
| 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 |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
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
|
|
|
Meningococcal Vaccine, IM 90734VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
5096654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$233.06 |
| 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 |
$173.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.00
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.06
|
| 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: United Healthcare Medicaid |
$173.42
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Meningococcal Vaccine, SC 90733
|
Facility
|
OP
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
Meningococcal Vaccine, SC 90733
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.85 |
| Max. Negotiated Rate |
$364.57 |
| Rate for Payer: Aetna Commercial |
$364.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$364.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.26
|
| Rate for Payer: Health EOS Commercial |
$349.22
|
| Rate for Payer: HFN Commercial |
$364.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.19
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$364.57
|
| Rate for Payer: Quartz Beloit One Network |
$168.85
|
| Rate for Payer: Quartz Commercial |
$218.74
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
Meningococcal Vaccine, SC 90733
|
Facility
|
IP
|
$369.00
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
3444852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$19.93 |
| 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: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.12
|
| 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 |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$224.19 |
| 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 |
$13.00
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.19
|
| 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 |
$16.05
|
|
|
Meningococcal Vaccine, SC 90733VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90733
|
| Hospital Charge Code |
5140608
|
|
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
|
|
|
MENISCAL CINCH AR-4500
|
Facility
|
IP
|
$5,358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.44 |
| Max. Negotiated Rate |
$5,126.53 |
| Rate for Payer: Aetna Commercial |
$5,015.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,792.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,953.33
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$5,126.53
|
| Rate for Payer: Health EOS Commercial |
$4,959.36
|
| Rate for Payer: HFN Commercial |
$5,126.53
|
| Rate for Payer: Multiplan Commercial |
$4,457.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,126.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,730.44
|
| Rate for Payer: Quartz Commercial |
$3,343.39
|
| Rate for Payer: WEA Trust Commercial |
$3,064.78
|
| Rate for Payer: WPS Commercial |
$4,127.27
|
|
|
MENISCAL CINCH AR-4500
|
Facility
|
OP
|
$5,358.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2964712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.25 |
| Max. Negotiated Rate |
$5,126.53 |
| Rate for Payer: Aetna Commercial |
$5,015.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,792.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,560.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,622.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,786.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,674.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,953.33
|
| Rate for Payer: Cash Price |
$1,607.40
|
| Rate for Payer: Cigna Commercial |
$5,126.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,118.36
|
| Rate for Payer: Health EOS Commercial |
$4,959.36
|
| Rate for Payer: HFN Commercial |
$5,126.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,179.24
|
| Rate for Payer: Multiplan Commercial |
$4,457.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,343.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,126.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,730.44
|
| Rate for Payer: Quartz Commercial |
$3,622.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3,343.39
|
| Rate for Payer: The Alliance Commercial |
$2,786.16
|
| Rate for Payer: WEA Trust Commercial |
$3,064.78
|
| Rate for Payer: WPS Commercial |
$4,127.27
|
|
|
MENISCAL CINCH SPEEDCINCH AR-4501
|
Facility
|
IP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,549.02 |
| Max. Negotiated Rate |
$4,785.91 |
| Rate for Payer: Aetna Commercial |
$4,681.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.10
|
| Rate for Payer: Cash Price |
$1,500.60
|
| Rate for Payer: Cigna Commercial |
$4,785.91
|
| Rate for Payer: Health EOS Commercial |
$4,629.85
|
| Rate for Payer: HFN Commercial |
$4,785.91
|
| Rate for Payer: Multiplan Commercial |
$4,161.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.02
|
| Rate for Payer: Quartz Commercial |
$3,121.25
|
| Rate for Payer: WEA Trust Commercial |
$2,861.14
|
| Rate for Payer: WPS Commercial |
$3,853.04
|
|
|
MENISCAL CINCH SPEEDCINCH AR-4501
|
Facility
|
OP
|
$5,002.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.58 |
| Max. Negotiated Rate |
$4,785.91 |
| Rate for Payer: Aetna Commercial |
$4,681.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,473.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,381.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,601.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,497.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,757.10
|
| Rate for Payer: Cash Price |
$1,500.60
|
| Rate for Payer: Cigna Commercial |
$4,785.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,911.16
|
| Rate for Payer: Health EOS Commercial |
$4,629.85
|
| Rate for Payer: HFN Commercial |
$4,785.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,901.56
|
| Rate for Payer: Multiplan Commercial |
$4,161.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,121.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,785.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.02
|
| Rate for Payer: Quartz Commercial |
$3,381.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,121.25
|
| Rate for Payer: The Alliance Commercial |
$2,601.04
|
| Rate for Payer: WEA Trust Commercial |
$2,861.14
|
| Rate for Payer: WPS Commercial |
$3,853.04
|
|
|
MENISCECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
MENISCECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 5322
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
