|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$31,883.00
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$11,468.81 |
| Max. Negotiated Rate |
$31,883.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,468.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,966.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,136.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,180.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11,468.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,468.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,468.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,468.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,182.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,468.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,150.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,468.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,468.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,468.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,468.81
|
| Rate for Payer: NAPHCARE Commercial |
$17,203.22
|
| Rate for Payer: Quartz Medicare Advantage |
$11,468.81
|
| Rate for Payer: The Alliance Commercial |
$31,883.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,468.81
|
| Rate for Payer: United Healthcare PPO |
$18,022.88
|
| Rate for Payer: Wellcare Medicare |
$11,468.81
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$46,258.00
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$16,639.68 |
| Max. Negotiated Rate |
$46,258.00 |
| Rate for Payer: Wellcare Medicare |
$16,639.68
|
| Rate for Payer: Aetna Managed Medicare |
$16,639.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,295.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,820.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,430.94
|
| Rate for Payer: Anthem Medicare Advantage |
$16,639.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,639.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,639.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,639.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,340.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,639.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,694.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,639.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,639.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,639.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,639.68
|
| Rate for Payer: NAPHCARE Commercial |
$24,959.52
|
| Rate for Payer: Quartz Medicare Advantage |
$16,639.68
|
| Rate for Payer: The Alliance Commercial |
$46,258.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,639.68
|
| Rate for Payer: United Healthcare PPO |
$26,231.25
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$24,179.00
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$8,697.37 |
| Max. Negotiated Rate |
$24,179.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,697.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,882.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,472.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,750.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,697.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,697.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,697.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,697.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,263.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,697.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,499.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,697.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,697.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,697.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,697.37
|
| Rate for Payer: NAPHCARE Commercial |
$13,046.06
|
| Rate for Payer: Quartz Medicare Advantage |
$8,697.37
|
| Rate for Payer: The Alliance Commercial |
$24,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,697.37
|
| Rate for Payer: United Healthcare PPO |
$13,623.43
|
| Rate for Payer: Wellcare Medicare |
$8,697.37
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058223
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,852.69 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,251.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,268.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,268.60
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
IP
|
$3,928.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058216
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,924.72 |
| Max. Negotiated Rate |
$3,613.76 |
| Rate for Payer: Aetna Commercial |
$3,535.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,081.84
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cigna Commercial |
$3,613.76
|
| Rate for Payer: Health EOS Commercial |
$3,495.92
|
| Rate for Payer: HFN Commercial |
$3,613.76
|
| Rate for Payer: Multiplan Commercial |
$3,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,356.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,613.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,924.72
|
| Rate for Payer: Quartz Commercial |
$2,356.80
|
| Rate for Payer: WEA Trust Commercial |
$2,160.40
|
| Rate for Payer: WPS Commercial |
$2,909.47
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
OP
|
$3,928.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058216
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$3,613.76 |
| Rate for Payer: Aetna Commercial |
$3,535.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,378.08
|
| Rate for Payer: Aetna Managed Medicare |
$529.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,081.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.77
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cigna Commercial |
$3,613.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$529.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,198.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$529.77
|
| Rate for Payer: Health EOS Commercial |
$3,495.92
|
| Rate for Payer: HFN Commercial |
$3,613.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$529.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$529.77
|
| Rate for Payer: Multiplan Commercial |
$3,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$794.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,613.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,924.72
|
| Rate for Payer: Quartz Commercial |
$2,553.20
|
| Rate for Payer: Quartz Medicare Advantage |
$529.77
|
| Rate for Payer: The Alliance Commercial |
$2,119.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.77
|
| Rate for Payer: United Healthcare PPO |
$2,946.00
|
| Rate for Payer: WEA Trust Commercial |
$2,160.40
|
| Rate for Payer: Wellcare Medicare |
$529.77
|
| Rate for Payer: WPS Commercial |
$2,909.47
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
OP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058223
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,251.66
|
| Rate for Payer: Aetna Managed Medicare |
$529.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.77
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$529.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,115.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$529.77
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$529.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$529.77
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$794.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,457.65
|
| Rate for Payer: Quartz Medicare Advantage |
$529.77
|
| Rate for Payer: The Alliance Commercial |
$2,119.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.77
|
| Rate for Payer: United Healthcare PPO |
$2,835.75
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: Wellcare Medicare |
$529.77
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
MUMFORD PROCEDURE/CLAVICLE RESECTION, DISTAL/SUBACROMIAL DECOMPRESSION
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
MUMFORD PROCEDURE/CLAVICLE RESECTION, DISTAL/SUBACROMIAL DECOMPRESSION
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
Mumps Antibody IgG
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.00
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: HFN Commercial |
$408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.07
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: The Alliance Commercial |
$215.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Mumps Antibody IgG
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Mumps Antibody IgG
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$13.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.66
|
| Rate for Payer: Anthem Medicaid |
$13.48
|
| Rate for Payer: Anthem Medicare Advantage |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.05
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Dean Health Medicaid |
$13.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.05
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.05
|
| Rate for Payer: Managed Health Services Medicaid |
$14.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.58
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.48
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13.05
|
| Rate for Payer: The Alliance Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicaid |
$13.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare PPO |
$322.50
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: Wellcare Medicare |
$13.05
|
| Rate for Payer: WMAP Medicaid |
$13.48
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
Mumps Antibody IgM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$13.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.66
|
| Rate for Payer: Anthem Medicaid |
$13.48
|
| Rate for Payer: Anthem Medicare Advantage |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.05
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Dean Health Medicaid |
$13.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.05
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.05
|
| Rate for Payer: Managed Health Services Medicaid |
$14.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.58
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.48
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$13.05
|
| Rate for Payer: The Alliance Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicaid |
$13.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.05
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: Wellcare Medicare |
$13.05
|
| Rate for Payer: WMAP Medicaid |
$13.48
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Mumps Antibody IgM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Mumps Antibody IgM
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.07
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Mumps RNA Qual PCR
|
Facility
|
OP
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$161.46 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.93
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$161.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.21
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$156.20
|
| Rate for Payer: HFN Commercial |
$161.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$161.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$86.00
|
| Rate for Payer: Quartz Commercial |
$114.08
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$131.62
|
| Rate for Payer: WEA Trust Commercial |
$96.52
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$129.99
|
|
|
Mumps RNA Qual PCR
|
Professional
|
Both
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.22 |
| Max. Negotiated Rate |
$166.72 |
| Rate for Payer: Aetna Commercial |
$166.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.93
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$166.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.30
|
| Rate for Payer: Health EOS Commercial |
$159.70
|
| Rate for Payer: HFN Commercial |
$166.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$166.72
|
| Rate for Payer: Quartz Beloit One Network |
$77.22
|
| Rate for Payer: Quartz Commercial |
$100.04
|
| Rate for Payer: The Alliance Commercial |
$87.75
|
| Rate for Payer: WEA Trust Commercial |
$96.52
|
| Rate for Payer: WPS Commercial |
$129.99
|
|
|
Mumps RNA Qual PCR
|
Facility
|
IP
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$161.46 |
| Rate for Payer: Aetna Commercial |
$157.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.02
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$161.46
|
| Rate for Payer: Health EOS Commercial |
$156.20
|
| Rate for Payer: HFN Commercial |
$161.46
|
| Rate for Payer: Multiplan Commercial |
$140.40
|
| Rate for Payer: NAPHCARE Commercial |
$105.30
|
| Rate for Payer: Preferred Network Access Commercial |
$161.46
|
| Rate for Payer: Quartz Beloit One Network |
$86.00
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: WEA Trust Commercial |
$96.52
|
| Rate for Payer: WPS Commercial |
$129.99
|
|
|
MUPIROCIN TOPICAL 2% OINTMENT (MED)
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
5415725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.91
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
MUPIROCIN TOPICAL 2% OINTMENT (MED)
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
5415725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
MURPHY RING SPLINT
|
Facility
|
OP
|
$1,076.00
|
|
| Hospital Charge Code |
2971403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.28 |
| Max. Negotiated Rate |
$4,304.00 |
| Rate for Payer: Aetna Commercial |
$968.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$925.36
|
| Rate for Payer: Aetna Managed Medicare |
$301.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$699.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$538.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.28
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$989.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.13
|
| Rate for Payer: Health EOS Commercial |
$957.64
|
| Rate for Payer: HFN Commercial |
$989.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.00
|
| Rate for Payer: Multiplan Commercial |
$860.80
|
| Rate for Payer: NAPHCARE Commercial |
$645.60
|
| Rate for Payer: Preferred Network Access Commercial |
$989.92
|
| Rate for Payer: Quartz Beloit One Network |
$527.24
|
| Rate for Payer: Quartz Commercial |
$699.40
|
| Rate for Payer: Quartz Medicare Advantage |
$645.60
|
| Rate for Payer: The Alliance Commercial |
$4,304.00
|
| Rate for Payer: WEA Trust Commercial |
$591.80
|
| Rate for Payer: WPS Commercial |
$796.99
|
|
|
MURPHY RING SPLINT
|
Facility
|
IP
|
$1,076.00
|
|
| Hospital Charge Code |
2971403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.24 |
| Max. Negotiated Rate |
$989.92 |
| Rate for Payer: Aetna Commercial |
$968.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$925.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.28
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$989.92
|
| Rate for Payer: Health EOS Commercial |
$957.64
|
| Rate for Payer: HFN Commercial |
$989.92
|
| Rate for Payer: Multiplan Commercial |
$860.80
|
| Rate for Payer: NAPHCARE Commercial |
$645.60
|
| Rate for Payer: Preferred Network Access Commercial |
$989.92
|
| Rate for Payer: Quartz Beloit One Network |
$527.24
|
| Rate for Payer: Quartz Commercial |
$645.60
|
| Rate for Payer: WEA Trust Commercial |
$591.80
|
| Rate for Payer: WPS Commercial |
$796.99
|
|
|
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK
|
Facility
|
OP
|
$14,184.12
|
|
|
Service Code
|
CPT 15734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,546.03 |
| Max. Negotiated Rate |
$14,184.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,546.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,546.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,546.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,546.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,546.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,546.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,191.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,546.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,546.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,546.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,546.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.03
|
| Rate for Payer: The Alliance Commercial |
$14,184.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,546.03
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,546.03
|
|
|
MUSCLE-SKIN GRAFT, TRUNK 15734
|
Professional
|
Both
|
$10,065.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
3013647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,264.52 |
| Max. Negotiated Rate |
$9,561.75 |
| Rate for Payer: Aetna Commercial |
$9,561.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,655.90
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cash Price |
$3,019.50
|
| Rate for Payer: Cigna Commercial |
$9,561.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,039.00
|
| Rate for Payer: Health EOS Commercial |
$9,159.15
|
| Rate for Payer: HFN Commercial |
$9,561.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,914.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,914.89
|
| Rate for Payer: Multiplan Commercial |
$8,052.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,561.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.60
|
| Rate for Payer: Quartz Commercial |
$5,737.05
|
| Rate for Payer: The Alliance Commercial |
$5,032.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,264.52
|
| Rate for Payer: WEA Trust Commercial |
$5,535.75
|
| Rate for Payer: WPS Commercial |
$7,455.15
|
|
|
MUSCLE-SKIN GRAFT, TRUNK, UNL 4999915734
|
Professional
|
Both
|
$10,064.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
6172052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,428.16 |
| Max. Negotiated Rate |
$9,560.80 |
| Rate for Payer: Aetna Commercial |
$9,560.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,655.04
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cigna Commercial |
$9,560.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,032.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,038.40
|
| Rate for Payer: Health EOS Commercial |
$9,158.24
|
| Rate for Payer: HFN Commercial |
$9,560.80
|
| Rate for Payer: Multiplan Commercial |
$8,051.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,560.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,428.16
|
| Rate for Payer: Quartz Commercial |
$5,736.48
|
| Rate for Payer: The Alliance Commercial |
$5,032.00
|
| Rate for Payer: WEA Trust Commercial |
$5,535.20
|
| Rate for Payer: WPS Commercial |
$7,454.40
|
|
