|
Monoclonal Protein Study 24 Urine
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Mononucleosis Screen
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Mononucleosis Screen
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Mononucleosis Screen
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Monovisc Inj 4ml J7327
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,500.26 |
| Max. Negotiated Rate |
$2,816.82 |
| Rate for Payer: Aetna Commercial |
$2,755.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.73
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,816.82
|
| Rate for Payer: Health EOS Commercial |
$2,724.97
|
| Rate for Payer: HFN Commercial |
$2,816.82
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,816.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.26
|
| Rate for Payer: Quartz Commercial |
$1,837.06
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: WPS Commercial |
$2,267.76
|
|
|
Monovisc Inj 4ml J7327
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$587.36 |
| Max. Negotiated Rate |
$2,908.67 |
| Rate for Payer: Aetna Commercial |
$2,908.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Aetna Managed Medicare |
$587.36
|
| Rate for Payer: Anthem Medicare Advantage |
$587.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$587.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$587.36
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,908.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$587.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.00
|
| Rate for Payer: Health EOS Commercial |
$2,786.20
|
| Rate for Payer: HFN Commercial |
$2,908.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,076.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$587.36
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: NAPHCARE Commercial |
$881.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,908.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.17
|
| Rate for Payer: Quartz Commercial |
$1,745.20
|
| Rate for Payer: Quartz Medicare Advantage |
$587.36
|
| Rate for Payer: The Alliance Commercial |
$1,615.24
|
| Rate for Payer: United Healthcare Medicaid |
$587.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.36
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: WPS Commercial |
$1,850.01
|
|
|
Monovisc Inj 4ml J7327
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$587.36 |
| Max. Negotiated Rate |
$2,816.82 |
| Rate for Payer: Aetna Commercial |
$2,755.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Aetna Managed Medicare |
$587.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,469.64
|
| Rate for Payer: Anthem Medicare Advantage |
$587.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$587.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$587.36
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,816.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$587.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$587.36
|
| Rate for Payer: Health EOS Commercial |
$2,724.97
|
| Rate for Payer: HFN Commercial |
$2,816.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,184.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$587.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$587.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$587.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$587.36
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: NAPHCARE Commercial |
$881.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,816.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.26
|
| Rate for Payer: Quartz Commercial |
$1,990.14
|
| Rate for Payer: Quartz Medicare Advantage |
$587.36
|
| Rate for Payer: The Alliance Commercial |
$2,349.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$587.36
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: Wellcare Medicare |
$587.36
|
| Rate for Payer: WPS Commercial |
$1,850.01
|
|
|
Monsel's Solution 1oz [Med]
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
2974900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Monsel's Solution 1oz [Med]
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
2974900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.26
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$41.81
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$41.81
|
| Rate for Payer: The Alliance Commercial |
$34.84
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
MORCHER EYEJET 15A
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.10 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$559.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,297.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$998.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$958.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,497.60
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$1,198.08
|
| Rate for Payer: The Alliance Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
MORCHER EYEJET 15A
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
MORE THAN SEVEN LESIONS 11901
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 11901
|
| Hospital Charge Code |
3013579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$161.39 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$35.83
|
| Rate for Payer: Anthem Medicare Advantage |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.83
|
| 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 |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.83
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$53.74
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$35.83
|
| Rate for Payer: The Alliance Commercial |
$152.27
|
| Rate for Payer: United Healthcare Medicaid |
$20.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.83
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$161.23
|
|
|
Morphine 10mg/1ml (1ml SYR) [MED]
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
3031090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$14.35
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.35
|
| Rate for Payer: The Alliance Commercial |
$11.96
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Morphine 10mg/1ml (1ml SYR) [MED]
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
3031090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
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 |
$6.13 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.13
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$14.35
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.35
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$11.59
|
|
|
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 |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Morphine Level Blood
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: United Healthcare PPO |
$94.38
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Morphine Level Blood
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$119.55 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.50
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Morphine Level Blood
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5156616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Morphine, Quantitative Urine
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.69
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: The Alliance Commercial |
$97.24
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Morphine, Quantitative Urine
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Morphine, Quantitative Urine
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5100607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$54.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.86
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$116.69
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$116.69
|
| Rate for Payer: The Alliance Commercial |
$97.24
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Morphine Sulfate 10mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.13
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$11.59
|
|
|
Morphine Sulfate 10mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
Morphine Sulfate 2mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
