|
MORCHER EYEJET 15A
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$7,680.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Aetna Managed Medicare |
$537.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,248.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$960.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.43
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,152.00
|
| Rate for Payer: The Alliance Commercial |
$7,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
|
MORE THAN SEVEN LESIONS 11901
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
3013579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$155.18 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$131.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$125.58
|
| Rate for Payer: HFN Commercial |
$131.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.18
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$131.10
|
| Rate for Payer: Quartz Beloit One Network |
$60.72
|
| Rate for Payer: Quartz Commercial |
$78.66
|
| Rate for Payer: The Alliance Commercial |
$69.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.92
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Morphine 10mg/1ml (1ml SYR) [MED]
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
3031090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Morphine 10mg/1ml (1ml SYR) [MED]
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
3031090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.80
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Morphine 4mg/1ml (1ml SYR) [MED]
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
3031092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Morphine 4mg/1ml (1ml SYR) [MED]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
3031092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.80
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$11.14
|
|
|
Morphine Level Blood
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Morphine Level Blood
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: United Healthcare PPO |
$90.75
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Morphine Level Blood
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$114.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.60
|
| Rate for Payer: Health EOS Commercial |
$110.11
|
| Rate for Payer: HFN Commercial |
$114.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.95
|
| Rate for Payer: Quartz Beloit One Network |
$53.24
|
| Rate for Payer: Quartz Commercial |
$68.97
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Morphine, Quantitative Urine
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Morphine, Quantitative Urine
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$52.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$112.20
|
| Rate for Payer: The Alliance Commercial |
$748.00
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Morphine, Quantitative Urine
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Morphine Sulfate 10mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$11.14
|
|
|
Morphine Sulfate 10mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Morphine Sulfate 2mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Morphine Sulfate 2mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$11.14
|
|
|
Morphine Sulfate 4mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Morphine Sulfate 4mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$11.14
|
|
|
Morphometric Analysis, BCR
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,982.60 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,205.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,400.75
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$1,616.25
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
Morphometric Analysis, BCR
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,055.95 |
| Max. Negotiated Rate |
$1,982.60 |
| Rate for Payer: Aetna Commercial |
$1,939.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,142.15
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,982.60
|
| Rate for Payer: Health EOS Commercial |
$1,917.95
|
| Rate for Payer: HFN Commercial |
$1,982.60
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,293.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,982.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,055.95
|
| Rate for Payer: Quartz Commercial |
$1,293.00
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
Morphometric Analysis, BCR
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$2,047.25 |
| Rate for Payer: Aetna Commercial |
$2,047.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,853.30
|
| Rate for Payer: Anthem Commercial |
$76.62
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,047.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,077.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,293.00
|
| Rate for Payer: Health EOS Commercial |
$1,961.05
|
| Rate for Payer: HFN Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$459.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$459.89
|
| Rate for Payer: Multiplan Commercial |
$1,724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,047.25
|
| Rate for Payer: Quartz Beloit One Network |
$948.20
|
| Rate for Payer: Quartz Commercial |
$1,228.35
|
| Rate for Payer: The Alliance Commercial |
$1,077.50
|
| Rate for Payer: WEA Trust Commercial |
$1,185.25
|
| Rate for Payer: WPS Commercial |
$1,596.21
|
|
|
MORTON'S NEUROMA, EXCISION
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
MORTON'S NEUROMA, EXCISION
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Motor&/sens 11-12 nrv cnd test 95912
|
Professional
|
Both
|
$3,640.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
3149527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$200.68 |
| Max. Negotiated Rate |
$3,458.00 |
| Rate for Payer: Aetna Commercial |
$3,458.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,130.40
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,458.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,184.00
|
| Rate for Payer: Health EOS Commercial |
$3,312.40
|
| Rate for Payer: HFN Commercial |
$3,458.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$897.11
|
| Rate for Payer: Multiplan Commercial |
$2,912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,458.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,601.60
|
| Rate for Payer: Quartz Commercial |
$2,074.80
|
| Rate for Payer: The Alliance Commercial |
$1,820.00
|
| Rate for Payer: United Healthcare Medicaid |
$200.68
|
| Rate for Payer: WEA Trust Commercial |
$2,002.00
|
| Rate for Payer: WPS Commercial |
$2,696.15
|
|
|
Motor&/sens 11-12 nrv cnd test 9591226
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
CPT 95912 26
|
| Hospital Charge Code |
3850015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$200.68 |
| Max. Negotiated Rate |
$1,402.20 |
| Rate for Payer: Aetna Commercial |
$1,402.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,269.36
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$1,402.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$885.60
|
| Rate for Payer: Health EOS Commercial |
$1,343.16
|
| Rate for Payer: HFN Commercial |
$1,402.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.15
|
| Rate for Payer: Multiplan Commercial |
$1,180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.20
|
| Rate for Payer: Quartz Beloit One Network |
$649.44
|
| Rate for Payer: Quartz Commercial |
$841.32
|
| Rate for Payer: The Alliance Commercial |
$738.00
|
| Rate for Payer: United Healthcare Medicaid |
$200.68
|
| Rate for Payer: WEA Trust Commercial |
$811.80
|
| Rate for Payer: WPS Commercial |
$1,093.27
|
|
