|
ROOM/BED: Special Care
|
Facility
|
IP
|
$1,900.00
|
|
| Hospital Charge Code |
2944498
|
|
Hospital Revenue Code
|
127
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$1,817.92 |
| Rate for Payer: Aetna Commercial |
$1,778.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,699.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,047.28
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$1,817.92
|
| Rate for Payer: Health EOS Commercial |
$1,758.64
|
| Rate for Payer: HFN Commercial |
$1,817.92
|
| Rate for Payer: Multiplan Commercial |
$1,580.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.92
|
| Rate for Payer: Quartz Beloit One Network |
$968.24
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: WEA Trust Commercial |
$1,086.80
|
| Rate for Payer: WPS Commercial |
$1,463.57
|
|
|
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 |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
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 |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
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 |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
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 |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
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 |
$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
|
|
|
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 |
$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: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| 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 |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
ROTATOR CUFF REPAIR/ACROMIOPLASTY/BANKHART PROCEDURE
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
ROTATOR CUFF REPAIR/ACROMIOPLASTY/BANKHART PROCEDURE
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
Rotavirus Antigen Detection to Quest
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Rotavirus Antigen Detection to Quest
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$54.82 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Rotavirus Antigen Detection to Quest
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
5472909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$49.84 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
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 |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
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 |
$97.93 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.54
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: United Healthcare Medicaid |
$106.85
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
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 |
$62.32 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.92
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$133.54
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$133.54
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
ROUTER VORTEX 3.5MM
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2964948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
ROUTER VORTEX 3.5MM
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2964948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
ROUTINE PRENATAL CARE
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00766
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
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 |
$636.11 |
| Max. Negotiated Rate |
$3,948.05 |
| Rate for Payer: Aetna Commercial |
$3,948.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,574.02
|
| 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 |
$3,948.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$638.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,493.50
|
| Rate for Payer: Health EOS Commercial |
$3,781.81
|
| Rate for Payer: HFN Commercial |
$3,948.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$636.11
|
| Rate for Payer: Multiplan Commercial |
$3,324.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,948.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,828.57
|
| Rate for Payer: Quartz Commercial |
$2,368.83
|
| Rate for Payer: The Alliance Commercial |
$2,077.92
|
| Rate for Payer: United Healthcare Medicaid |
$638.02
|
| Rate for Payer: WEA Trust Commercial |
$2,285.71
|
| Rate for Payer: WPS Commercial |
$3,078.12
|
|
|
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 |
$745.53 |
| Max. Negotiated Rate |
$8,377.25 |
| Rate for Payer: Aetna Commercial |
$8,377.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,583.62
|
| Rate for Payer: Aetna Managed Medicare |
$852.87
|
| Rate for Payer: Anthem Medicare Advantage |
$852.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$852.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$852.87
|
| 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 |
$8,377.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$745.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.87
|
| Rate for Payer: Health EOS Commercial |
$8,024.53
|
| Rate for Payer: HFN Commercial |
$8,377.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$852.87
|
| Rate for Payer: Multiplan Commercial |
$7,054.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.31
|
| Rate for Payer: Preferred Network Access Commercial |
$8,377.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,879.99
|
| Rate for Payer: Quartz Commercial |
$5,026.35
|
| Rate for Payer: Quartz Medicare Advantage |
$852.87
|
| Rate for Payer: The Alliance Commercial |
$3,624.71
|
| Rate for Payer: United Healthcare Medicaid |
$745.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$852.87
|
| Rate for Payer: WEA Trust Commercial |
$4,849.99
|
| Rate for Payer: WPS Commercial |
$3,837.93
|
|
|
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 |
$745.53 |
| Max. Negotiated Rate |
$10,052.90 |
| Rate for Payer: Aetna Commercial |
$10,052.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,100.52
|
| 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 |
$10,052.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$745.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,349.20
|
| Rate for Payer: Health EOS Commercial |
$9,629.62
|
| Rate for Payer: HFN Commercial |
$10,052.90
|
| Rate for Payer: Multiplan Commercial |
$8,465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,052.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,656.08
|
| Rate for Payer: Quartz Commercial |
$6,031.74
|
| Rate for Payer: The Alliance Commercial |
$5,291.00
|
| Rate for Payer: United Healthcare Medicaid |
$745.53
|
| Rate for Payer: WEA Trust Commercial |
$5,820.10
|
| Rate for Payer: WPS Commercial |
$7,837.80
|
|
|
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 |
$561.15 |
| Max. Negotiated Rate |
$7,699.48 |
| Rate for Payer: Aetna Commercial |
$7,699.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,970.06
|
| Rate for Payer: Aetna Managed Medicare |
$643.31
|
| Rate for Payer: Anthem Medicare Advantage |
$643.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.31
|
| 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 |
$7,699.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$561.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$643.31
|
| Rate for Payer: Health EOS Commercial |
$7,375.30
|
| Rate for Payer: HFN Commercial |
$7,699.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$643.31
|
| Rate for Payer: Multiplan Commercial |
$6,483.78
|
| Rate for Payer: NAPHCARE Commercial |
$964.97
|
| Rate for Payer: Preferred Network Access Commercial |
$7,699.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,566.08
|
| Rate for Payer: Quartz Commercial |
$4,619.69
|
| Rate for Payer: Quartz Medicare Advantage |
$643.31
|
| Rate for Payer: The Alliance Commercial |
$2,734.08
|
| Rate for Payer: United Healthcare Medicaid |
$561.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.31
|
| Rate for Payer: WEA Trust Commercial |
$4,457.60
|
| Rate for Payer: WPS Commercial |
$2,894.91
|
|
|
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 |
$417.23 |
| Max. Negotiated Rate |
$3,851.22 |
| Rate for Payer: Aetna Commercial |
$3,851.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,486.37
|
| Rate for Payer: Aetna Managed Medicare |
$478.78
|
| Rate for Payer: Anthem Medicare Advantage |
$478.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$478.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$478.78
|
| 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 |
$3,851.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$417.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.78
|
| Rate for Payer: Health EOS Commercial |
$3,689.07
|
| Rate for Payer: HFN Commercial |
$3,851.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$478.78
|
| Rate for Payer: Multiplan Commercial |
$3,243.14
|
| Rate for Payer: NAPHCARE Commercial |
$718.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,851.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,783.72
|
| Rate for Payer: Quartz Commercial |
$2,310.73
|
| Rate for Payer: Quartz Medicare Advantage |
$478.78
|
| Rate for Payer: The Alliance Commercial |
$2,034.84
|
| Rate for Payer: United Healthcare Medicaid |
$417.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$478.78
|
| Rate for Payer: WEA Trust Commercial |
$2,229.66
|
| Rate for Payer: WPS Commercial |
$2,154.53
|
|
|
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 |
$346.05 |
| Max. Negotiated Rate |
$3,176.42 |
| Rate for Payer: Aetna Commercial |
$3,176.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.50
|
| Rate for Payer: Aetna Managed Medicare |
$398.54
|
| Rate for Payer: Anthem Medicare Advantage |
$398.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$398.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$398.54
|
| 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 |
$3,176.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$346.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.54
|
| Rate for Payer: Health EOS Commercial |
$3,042.68
|
| Rate for Payer: HFN Commercial |
$3,176.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$398.54
|
| Rate for Payer: Multiplan Commercial |
$2,674.88
|
| Rate for Payer: NAPHCARE Commercial |
$597.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,176.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,471.18
|
| Rate for Payer: Quartz Commercial |
$1,905.85
|
| Rate for Payer: Quartz Medicare Advantage |
$398.54
|
| Rate for Payer: The Alliance Commercial |
$1,693.79
|
| Rate for Payer: United Healthcare Medicaid |
$346.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$398.54
|
| Rate for Payer: WEA Trust Commercial |
$1,838.98
|
| Rate for Payer: WPS Commercial |
$1,793.42
|
|
|
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 |
$249.37 |
| Max. Negotiated Rate |
$2,440.36 |
| Rate for Payer: Aetna Commercial |
$2,440.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,209.17
|
| Rate for Payer: Aetna Managed Medicare |
$289.31
|
| Rate for Payer: Anthem Medicare Advantage |
$289.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$289.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$289.31
|
| 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 |
$2,440.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Health EOS Commercial |
$2,337.61
|
| Rate for Payer: HFN Commercial |
$2,440.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$289.31
|
| Rate for Payer: Multiplan Commercial |
$2,055.04
|
| Rate for Payer: NAPHCARE Commercial |
$433.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,130.27
|
| Rate for Payer: Quartz Commercial |
$1,464.22
|
| Rate for Payer: Quartz Medicare Advantage |
$289.31
|
| Rate for Payer: The Alliance Commercial |
$1,229.56
|
| Rate for Payer: United Healthcare Medicaid |
$249.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.31
|
| Rate for Payer: WEA Trust Commercial |
$1,412.84
|
| Rate for Payer: WPS Commercial |
$1,301.88
|
|
