|
Mesnex 200 mg Charge
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
2958981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$56.32 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$1.77
|
| Rate for Payer: Anthem Medicare Advantage |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.77
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.83
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$2.65
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1.77
|
| Rate for Payer: The Alliance Commercial |
$4.86
|
| Rate for Payer: United Healthcare Medicaid |
$1.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.77
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$4.58
|
|
|
Mesnex 200 mg Charge
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
2958981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metal Clip Placement Breast Biopsy MA
|
Professional
|
Both
|
$602.00
|
|
| Hospital Charge Code |
3792844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.48 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.65
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metal Clip Placement Breast Biopsy US
|
Professional
|
Both
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$275.48 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.65
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metal Clip Placement Breast Biopsy US
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metal Clip Placement Breast Biopsy US
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
3792846
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
Metalic Biopsy Marker
|
Professional
|
Both
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.26 |
| Max. Negotiated Rate |
$436.70 |
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$436.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.81
|
| Rate for Payer: Health EOS Commercial |
$418.31
|
| Rate for Payer: HFN Commercial |
$436.70
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$436.70
|
| Rate for Payer: Quartz Beloit One Network |
$202.26
|
| Rate for Payer: Quartz Commercial |
$262.02
|
| Rate for Payer: The Alliance Commercial |
$229.84
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Metalic Biopsy Marker
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$128.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$298.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.24
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.76
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$275.81
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| Rate for Payer: Quartz Medicare Advantage |
$275.81
|
| Rate for Payer: The Alliance Commercial |
$229.84
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Metalic Biopsy Marker
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
1158868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$325.05 |
| Rate for Payer: Aetna Commercial |
$325.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$325.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$311.37
|
| Rate for Payer: HFN Commercial |
$325.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$325.05
|
| Rate for Payer: Quartz Beloit One Network |
$150.55
|
| Rate for Payer: Quartz Commercial |
$195.03
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$69.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$77.52
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.25
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: United Healthcare PPO |
$256.62
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: Wellcare Medicare |
$17.62
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
Metanephrines, Fractionated, 24 Hr Urine
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$320.11 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$320.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$306.63
|
| Rate for Payer: HFN Commercial |
$320.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$320.11
|
| Rate for Payer: Quartz Beloit One Network |
$148.26
|
| Rate for Payer: Quartz Commercial |
$192.07
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$69.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$77.52
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$202.18
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
Metanephrines, Fractionated, Free, Plasma
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
983321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.25
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$219.02
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: United Healthcare PPO |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: Wellcare Medicare |
$17.62
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
Metanephrines Fract Rand Urine
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Metanephrines Fract Rand Urine
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$70.47 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.25
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$17.62
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Metanephrines Fract Rand Urine
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
6182172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$17.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.62
|
| 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 |
$17.62
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.43
|
| 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 |
$17.62
|
| Rate for Payer: The Alliance Commercial |
$69.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.62
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$77.52
|
|
|
METATARSAL BARS MEDIUM
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2970845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
METATARSAL BARS MEDIUM
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2970845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
METATARSAL HEAD RESECTION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
METATARSAL HEAD RESECTION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
Metformin, Blood
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4340650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$193.65 |
| Rate for Payer: Aetna Commercial |
$193.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$193.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$185.49
|
| Rate for Payer: HFN Commercial |
$193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$193.65
|
| Rate for Payer: Quartz Beloit One Network |
$89.69
|
| Rate for Payer: Quartz Commercial |
$116.19
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
