|
ROOM/BED: Special Care
|
Facility
|
IP
|
$1,900.00
|
|
| Hospital Charge Code |
2944498
|
|
Hospital Revenue Code
|
127
|
| Min. Negotiated Rate |
$931.00 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$1,710.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$1,748.00
|
| Rate for Payer: Health EOS Commercial |
$1,691.00
|
| Rate for Payer: HFN Commercial |
$1,748.00
|
| Rate for Payer: Multiplan Commercial |
$1,520.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.00
|
| Rate for Payer: Quartz Beloit One Network |
$931.00
|
| Rate for Payer: Quartz Commercial |
$1,140.00
|
| Rate for Payer: WEA Trust Commercial |
$1,045.00
|
| Rate for Payer: WPS Commercial |
$1,407.33
|
|
|
ropivacaine 0.5% Soln 20ml Ampl [MED]
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5107249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$34.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.25
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$73.80
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$0.17
|
|
|
ropivacaine 0.5% Soln 20ml Ampl [MED]
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5107249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
ropivacaine 0.5% Soln 20ml vial [MED]
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
3313458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
ropivacaine 0.5% Soln 20ml vial [MED]
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
3313458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$42.00
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$0.17
|
|
|
ROPIVICAINE 0.5% SOLN 30ML VIAL (MED)
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5895665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$0.17
|
|
|
ROPIVICAINE 0.5% SOLN 30ML VIAL (MED)
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5895665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
ROTATOR CUFF REPAIR/ACROMIOPLASTY/BANKHART PROCEDURE
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960358
|
|
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
|
|
|
ROTATOR CUFF REPAIR/ACROMIOPLASTY/BANKHART PROCEDURE
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960358
|
|
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
|
|
|
Rotavirus Antigen Detection to Quest
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.00
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Rotavirus Antigen Detection to Quest
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Rotavirus Antigen Detection to Quest
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$47.92 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Rotovirus Vacc 3 Dose, Oral 90680
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
3397517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$128.40
|
| Rate for Payer: The Alliance Commercial |
$856.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Rotovirus Vacc 3 Dose, Oral 90680
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
3397517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Rotovirus Vacc 3 Dose, Oral 90680
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
3397517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$203.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.40
|
| Rate for Payer: Health EOS Commercial |
$194.74
|
| Rate for Payer: HFN Commercial |
$203.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.06
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Preferred Network Access Commercial |
$203.30
|
| Rate for Payer: Quartz Beloit One Network |
$94.16
|
| Rate for Payer: Quartz Commercial |
$121.98
|
| Rate for Payer: The Alliance Commercial |
$107.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
ROUTER VORTEX 3.5MM
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2964948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
ROUTER VORTEX 3.5MM
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2964948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP 36581-22
|
Professional
|
Both
|
$3,996.00
|
|
|
Service Code
|
CPT 36581 22
|
| Hospital Charge Code |
5749624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$611.64 |
| Max. Negotiated Rate |
$3,796.20 |
| Rate for Payer: Aetna Commercial |
$3,796.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,436.56
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cash Price |
$1,198.80
|
| Rate for Payer: Cigna Commercial |
$3,796.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,397.60
|
| Rate for Payer: Health EOS Commercial |
$3,636.36
|
| Rate for Payer: HFN Commercial |
$3,796.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.64
|
| Rate for Payer: Multiplan Commercial |
$3,196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,796.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,758.24
|
| Rate for Payer: Quartz Commercial |
$2,277.72
|
| Rate for Payer: The Alliance Commercial |
$1,998.00
|
| Rate for Payer: United Healthcare Medicaid |
$613.48
|
| Rate for Payer: WEA Trust Commercial |
$2,197.80
|
| Rate for Payer: WPS Commercial |
$2,959.84
|
|
|
RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED 49596
|
Professional
|
Both
|
$8,479.00
|
|
|
Service Code
|
CPT 49596
|
| Hospital Charge Code |
6179960
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$716.86 |
| Max. Negotiated Rate |
$8,055.05 |
| Rate for Payer: Aetna Commercial |
$8,055.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,291.94
|
| Rate for Payer: Cash Price |
$2,543.70
|
| Rate for Payer: Cash Price |
$2,543.70
|
| Rate for Payer: Cash Price |
$2,543.70
|
| Rate for Payer: Cigna Commercial |
$8,055.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$716.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,087.40
|
| Rate for Payer: Health EOS Commercial |
$7,715.89
|
| Rate for Payer: HFN Commercial |
$8,055.05
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,055.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,730.76
|
| Rate for Payer: Quartz Commercial |
$4,833.03
|
| Rate for Payer: The Alliance Commercial |
$4,239.50
|
| Rate for Payer: United Healthcare Medicaid |
$716.86
|
| Rate for Payer: WEA Trust Commercial |
$4,663.45
|
| Rate for Payer: WPS Commercial |
$6,280.40
|
|
|
RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED, EXT CARE 4959622
|
Professional
|
Both
|
$10,175.00
|
|
|
Service Code
|
CPT 49596 22
|
| Hospital Charge Code |
6195224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$716.86 |
| Max. Negotiated Rate |
$9,666.25 |
| Rate for Payer: Aetna Commercial |
$9,666.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,750.50
|
| Rate for Payer: Cash Price |
$3,052.50
|
| Rate for Payer: Cash Price |
$3,052.50
|
| Rate for Payer: Cash Price |
$3,052.50
|
| Rate for Payer: Cigna Commercial |
$9,666.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$716.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,105.00
|
| Rate for Payer: Health EOS Commercial |
$9,259.25
|
| Rate for Payer: HFN Commercial |
$9,666.25
|
| Rate for Payer: Multiplan Commercial |
$8,140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,666.25
|
| Rate for Payer: Quartz Beloit One Network |
$4,477.00
|
| Rate for Payer: Quartz Commercial |
$5,799.75
|
| Rate for Payer: The Alliance Commercial |
$5,087.50
|
| Rate for Payer: United Healthcare Medicaid |
$716.86
|
| Rate for Payer: WEA Trust Commercial |
$5,596.25
|
| Rate for Payer: WPS Commercial |
$7,536.62
|
|
|
RPR AA HERNIA 1ST > 10 CM REDUCIBLE 49595
|
Professional
|
Both
|
$7,793.00
|
|
|
Service Code
|
CPT 49595
|
| Hospital Charge Code |
6179959
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$539.57 |
| Max. Negotiated Rate |
$7,403.35 |
| Rate for Payer: Aetna Commercial |
$7,403.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,701.98
|
| Rate for Payer: Cash Price |
$2,337.90
|
| Rate for Payer: Cash Price |
$2,337.90
|
| Rate for Payer: Cash Price |
$2,337.90
|
| Rate for Payer: Cigna Commercial |
$7,403.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$539.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,675.80
|
| Rate for Payer: Health EOS Commercial |
$7,091.63
|
| Rate for Payer: HFN Commercial |
$7,403.35
|
| Rate for Payer: Multiplan Commercial |
$6,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,403.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,428.92
|
| Rate for Payer: Quartz Commercial |
$4,442.01
|
| Rate for Payer: The Alliance Commercial |
$3,896.50
|
| Rate for Payer: United Healthcare Medicaid |
$539.57
|
| Rate for Payer: WEA Trust Commercial |
$4,286.15
|
| Rate for Payer: WPS Commercial |
$5,772.28
|
|
|
RPR AA HERNIA 1ST 3-10 CM REDUCIBLE 49593
|
Professional
|
Both
|
$3,898.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
6179957
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$3,703.10 |
| Rate for Payer: Aetna Commercial |
$3,703.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,352.28
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$3,703.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$401.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,338.80
|
| Rate for Payer: Health EOS Commercial |
$3,547.18
|
| Rate for Payer: HFN Commercial |
$3,703.10
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,703.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,715.12
|
| Rate for Payer: Quartz Commercial |
$2,221.86
|
| Rate for Payer: The Alliance Commercial |
$1,949.00
|
| Rate for Payer: United Healthcare Medicaid |
$401.18
|
| Rate for Payer: WEA Trust Commercial |
$2,143.90
|
| Rate for Payer: WPS Commercial |
$2,887.25
|
|
|
RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED 49592
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
6179956
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$3,054.25 |
| Rate for Payer: Aetna Commercial |
$3,054.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,764.90
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,054.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,929.00
|
| Rate for Payer: Health EOS Commercial |
$2,925.65
|
| Rate for Payer: HFN Commercial |
$3,054.25
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,054.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.60
|
| Rate for Payer: Quartz Commercial |
$1,832.55
|
| Rate for Payer: The Alliance Commercial |
$1,607.50
|
| Rate for Payer: United Healthcare Medicaid |
$332.74
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
RPR AA HERNIA 1ST < 3 CM REDUCIBLE 49591
|
Professional
|
Both
|
$2,470.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
6179955
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$239.78 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Aetna Commercial |
$2,346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,124.20
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,346.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,482.00
|
| Rate for Payer: Health EOS Commercial |
$2,247.70
|
| Rate for Payer: HFN Commercial |
$2,346.50
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.80
|
| Rate for Payer: Quartz Commercial |
$1,407.90
|
| Rate for Payer: The Alliance Commercial |
$1,235.00
|
| Rate for Payer: United Healthcare Medicaid |
$239.78
|
| Rate for Payer: WEA Trust Commercial |
$1,358.50
|
| Rate for Payer: WPS Commercial |
$1,829.53
|
|
|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED 49618
|
Professional
|
Both
|
$9,409.00
|
|
|
Service Code
|
CPT 49618
|
| Hospital Charge Code |
6179923
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$867.98 |
| Max. Negotiated Rate |
$8,938.55 |
| Rate for Payer: Aetna Commercial |
$8,938.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,091.74
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cigna Commercial |
$8,938.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$867.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,645.40
|
| Rate for Payer: Health EOS Commercial |
$8,562.19
|
| Rate for Payer: HFN Commercial |
$8,938.55
|
| Rate for Payer: Multiplan Commercial |
$7,527.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,938.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,139.96
|
| Rate for Payer: Quartz Commercial |
$5,363.13
|
| Rate for Payer: The Alliance Commercial |
$4,704.50
|
| Rate for Payer: United Healthcare Medicaid |
$867.98
|
| Rate for Payer: WEA Trust Commercial |
$5,174.95
|
| Rate for Payer: WPS Commercial |
$6,969.25
|
|
