|
Sodium hyaluronate 20 mg/mL Soln - Durolane
|
Professional
|
$37.00
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
5799848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Aetna Managed Medicare |
$6.06
|
| Rate for Payer: Anthem Medicare Advantage |
$6.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.06
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.55
|
| Rate for Payer: Health EOS Commercial |
$33.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Preferred Network Access Commercial |
$35.15
|
| Rate for Payer: Quartz Beloit One Network |
$16.28
|
| Rate for Payer: Quartz Commercial |
$21.09
|
| Rate for Payer: Quartz Medicare Advantage |
$6.06
|
| Rate for Payer: The Alliance Commercial |
$16.67
|
| Rate for Payer: United Healthcare Medicaid |
$6.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.06
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$16.38
|
|
|
Sodium Level
|
Professional
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$4.81
|
| Rate for Payer: Anthem Medicare Advantage |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.81
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.81
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$4.81
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.81
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$21.16
|
|
|
Sodium Level
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$4.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.98
|
| Rate for Payer: Anthem Medicaid |
$4.97
|
| Rate for Payer: Anthem Medicare Advantage |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.81
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.97
|
| Rate for Payer: Dean Health Medicaid |
$4.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.81
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.81
|
| Rate for Payer: Managed Health Services Medicaid |
$5.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.22
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.97
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4.81
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.81
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$4.81
|
| Rate for Payer: WMAP Medicaid |
$4.97
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Sodium Level
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Sodium Level 24 Hour Urine
|
Professional
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.06
|
| Rate for Payer: Anthem Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.06
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.06
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.06
|
| Rate for Payer: The Alliance Commercial |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$22.26
|
|
|
Sodium Level 24 Hour Urine
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Sodium Level 24 Hour Urine
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.40
|
| Rate for Payer: Anthem Medicaid |
$5.23
|
| Rate for Payer: Anthem Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.06
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.23
|
| Rate for Payer: Dean Health Medicaid |
$5.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.06
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.06
|
| Rate for Payer: Managed Health Services Medicaid |
$5.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.59
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.23
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.06
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$5.06
|
| Rate for Payer: WMAP Medicaid |
$5.23
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Sodium Level Stool
|
Professional
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$4.86
|
| Rate for Payer: Anthem Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.86
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.86
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4.86
|
| Rate for Payer: The Alliance Commercial |
$19.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$21.38
|
|
|
Sodium Level Stool
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$4.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.07
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.86
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.02
|
| Rate for Payer: Dean Health Medicaid |
$5.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.86
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.86
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.29
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.02
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4.86
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: United Healthcare PPO |
$69.75
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$4.86
|
| Rate for Payer: WMAP Medicaid |
$5.02
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Sodium Level Stool
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Sodium Level Urine
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$5.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.40
|
| Rate for Payer: Anthem Medicaid |
$5.23
|
| Rate for Payer: Anthem Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.06
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.23
|
| Rate for Payer: Dean Health Medicaid |
$5.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.06
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.06
|
| Rate for Payer: Managed Health Services Medicaid |
$5.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.59
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.23
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.06
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$5.06
|
| Rate for Payer: WMAP Medicaid |
$5.23
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Sodium Level Urine
|
Professional
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$5.06
|
| Rate for Payer: Anthem Medicare Advantage |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.06
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.06
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: Quartz Medicare Advantage |
$5.06
|
| Rate for Payer: The Alliance Commercial |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.06
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$22.26
|
|
|
Sodium Level Urine
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Sodium Tetradecyl 1% 2ml vial [Med]
|
Facility
OP
|
$931.00
|
|
| Hospital Charge Code |
2974982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$3,724.00 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Aetna Managed Medicare |
$260.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$446.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.99
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.25
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$605.15
|
| Rate for Payer: Quartz Medicare Advantage |
$558.60
|
| Rate for Payer: The Alliance Commercial |
$3,724.00
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
Sodium Tetradecyl 1% 2ml vial [Med]
|
Facility
IP
|
$931.00
|
|
| Hospital Charge Code |
2974982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$456.19 |
| Max. Negotiated Rate |
$856.52 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.43
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$856.52
|
| Rate for Payer: Health EOS Commercial |
$828.59
|
| Rate for Payer: HFN Commercial |
$856.52
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: NAPHCARE Commercial |
$558.60
|
| Rate for Payer: Preferred Network Access Commercial |
$856.52
|
| Rate for Payer: Quartz Beloit One Network |
$456.19
|
| Rate for Payer: Quartz Commercial |
$558.60
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLACK/BLUE) #2 SUTURE (BLUE/BLACK) AR
|
Facility
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,934.03 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLACK/BLUE) #2 SUTURE (BLUE/BLACK) AR
|
Facility
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.16 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,394.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,105.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,565.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,894.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.74
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,960.25
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,565.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLUE) #2 SUTURE (WHITE/BLACK) AR-3653
|
Facility
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,934.03 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLUE) #2 SUTURE (WHITE/BLACK) AR-3653
|
Facility
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.16 |
| Max. Negotiated Rate |
$3,631.24 |
| Rate for Payer: Aetna Commercial |
$3,552.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,394.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,105.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,565.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,973.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,894.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.91
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,631.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.74
|
| Rate for Payer: Health EOS Commercial |
$3,512.83
|
| Rate for Payer: HFN Commercial |
$3,631.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,960.25
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,368.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,631.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,934.03
|
| Rate for Payer: Quartz Commercial |
$2,565.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,368.20
|
| Rate for Payer: WEA Trust Commercial |
$2,170.85
|
| Rate for Payer: WPS Commercial |
$2,923.54
|
|
|
Soft Interface below Knee Se L2820
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
HCPCS L2820
|
| Hospital Charge Code |
4718607
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Aetna Managed Medicare |
$70.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.02
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$163.80
|
| Rate for Payer: Quartz Medicare Advantage |
$151.20
|
| Rate for Payer: The Alliance Commercial |
$1,008.00
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Soft Interface below Knee Se L2820
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
HCPCS L2820
|
| Hospital Charge Code |
4718607
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$231.84 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$151.20
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Soft Interface below Knee Se L2820
|
Professional
|
$252.00
|
|
|
Service Code
|
HCPCS L2820
|
| Hospital Charge Code |
4718607
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$287.73 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$239.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.20
|
| Rate for Payer: Health EOS Commercial |
$229.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.73
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$239.40
|
| Rate for Payer: Quartz Beloit One Network |
$110.88
|
| Rate for Payer: Quartz Commercial |
$143.64
|
| Rate for Payer: The Alliance Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
IP
|
$46,466.00
|
|
|
Service Code
|
MS-DRG 501
|
| Min. Negotiated Rate |
$16,714.27 |
| Max. Negotiated Rate |
$46,466.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,714.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,505.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,980.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,583.72
|
| Rate for Payer: Anthem Medicare Advantage |
$16,714.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,714.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,714.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,714.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,510.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,714.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,846.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,714.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,714.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,714.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,714.27
|
| Rate for Payer: NAPHCARE Commercial |
$25,071.40
|
| Rate for Payer: Quartz Medicare Advantage |
$16,714.27
|
| Rate for Payer: The Alliance Commercial |
$46,466.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,714.27
|
| Rate for Payer: United Healthcare PPO |
$26,349.66
|
| Rate for Payer: Wellcare Medicare |
$16,714.27
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
IP
|
$86,533.00
|
|
|
Service Code
|
MS-DRG 500
|
| Min. Negotiated Rate |
$31,127.12 |
| Max. Negotiated Rate |
$86,533.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,127.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,975.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,500.72
|
| Rate for Payer: Anthem Medicare Advantage |
$31,127.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,127.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,127.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,127.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,950.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,127.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,234.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,127.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,127.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,127.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,127.12
|
| Rate for Payer: NAPHCARE Commercial |
$46,690.68
|
| Rate for Payer: Quartz Medicare Advantage |
$31,127.12
|
| Rate for Payer: The Alliance Commercial |
$86,533.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,127.12
|
| Rate for Payer: United Healthcare PPO |
$49,228.95
|
| Rate for Payer: Wellcare Medicare |
$31,127.12
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$37,081.00
|
|
|
Service Code
|
MS-DRG 502
|
| Min. Negotiated Rate |
$13,338.44 |
| Max. Negotiated Rate |
$37,081.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,338.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,952.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,191.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,083.64
|
| Rate for Payer: Anthem Medicare Advantage |
$13,338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,338.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,338.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,404.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,338.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,962.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,338.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,338.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,338.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,338.44
|
| Rate for Payer: NAPHCARE Commercial |
$20,007.66
|
| Rate for Payer: Quartz Medicare Advantage |
$13,338.44
|
| Rate for Payer: The Alliance Commercial |
$37,081.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,338.44
|
| Rate for Payer: United Healthcare PPO |
$20,990.77
|
| Rate for Payer: Wellcare Medicare |
$13,338.44
|
|
