|
Solu-Medrol 125 mg Charge
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Solu-Medrol 125 mg Charge
|
Professional
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna Commercial |
$25.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$5.72
|
| Rate for Payer: Anthem Medicare Advantage |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.72
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.72
|
| Rate for Payer: Health EOS Commercial |
$24.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$25.65
|
| Rate for Payer: Quartz Beloit One Network |
$11.88
|
| Rate for Payer: Quartz Commercial |
$15.39
|
| Rate for Payer: Quartz Medicare Advantage |
$5.72
|
| Rate for Payer: The Alliance Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.72
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$10.02
|
|
|
Solu-Medrol 125 mg Charge
|
Facility
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Facility
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$19.80
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Facility
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Aetna Managed Medicare |
$9.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.47
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$21.45
|
| Rate for Payer: Quartz Medicare Advantage |
$19.80
|
| Rate for Payer: The Alliance Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Professional
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Aetna Managed Medicare |
$4.24
|
| Rate for Payer: Anthem Medicare Advantage |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.24
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.24
|
| Rate for Payer: Health EOS Commercial |
$30.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.24
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.35
|
| Rate for Payer: Quartz Beloit One Network |
$14.52
|
| Rate for Payer: Quartz Commercial |
$18.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4.24
|
| Rate for Payer: The Alliance Commercial |
$11.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.24
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Solution 1000 SOD CHL
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
3040286
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Solution 1000 SOD CHL
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
3040286
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Solution 500 Sod Chl
|
Facility
OP
|
$40.00
|
|
| Hospital Charge Code |
3101785
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Aetna Managed Medicare |
$11.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.38
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$26.00
|
| Rate for Payer: Quartz Medicare Advantage |
$24.00
|
| Rate for Payer: The Alliance Commercial |
$160.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Solution 500 Sod Chl
|
Facility
IP
|
$40.00
|
|
| Hospital Charge Code |
3101785
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Solution 500 SOD CHL
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
3040285
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Solution 500 SOD CHL
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
3040285
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
SOLUTION BALANCED SALINE 500ML BAG 0065179504
|
Facility
IP
|
$135.00
|
|
| Hospital Charge Code |
5107102
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
SOLUTION BALANCED SALINE 500ML BAG 0065179504
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
5107102
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$37.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.55
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$87.75
|
| Rate for Payer: Quartz Medicare Advantage |
$81.00
|
| Rate for Payer: The Alliance Commercial |
$540.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Somatostatin Level
|
Professional
|
$491.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
1043145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Aetna Commercial |
$466.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$18.28
|
| Rate for Payer: Anthem Medicare Advantage |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.28
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$466.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.28
|
| Rate for Payer: Health EOS Commercial |
$446.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.28
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Preferred Network Access Commercial |
$466.45
|
| Rate for Payer: Quartz Beloit One Network |
$216.04
|
| Rate for Payer: Quartz Commercial |
$279.87
|
| Rate for Payer: Quartz Medicare Advantage |
$18.28
|
| Rate for Payer: The Alliance Commercial |
$72.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.28
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$80.43
|
|
|
Somatostatin Level
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
1043145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$1,964.00 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$18.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.34
|
| Rate for Payer: Anthem Medicaid |
$12.48
|
| Rate for Payer: Anthem Medicare Advantage |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.28
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.48
|
| Rate for Payer: Dean Health Medicaid |
$12.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.28
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.28
|
| Rate for Payer: Managed Health Services Medicaid |
$12.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.28
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.42
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.48
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$319.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.28
|
| Rate for Payer: The Alliance Commercial |
$1,964.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.28
|
| Rate for Payer: United Healthcare PPO |
$368.25
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: Wellcare Medicare |
$18.28
|
| Rate for Payer: WMAP Medicaid |
$12.48
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
Somatostatin Level
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
1043145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$451.72 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$294.60
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
SONIC ANCHOR KIT 2.5 X 10MM 1910-1272S
|
Facility
IP
|
$3,609.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5917656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,768.41 |
| Max. Negotiated Rate |
$3,320.28 |
| Rate for Payer: Aetna Commercial |
$3,248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,912.77
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cigna Commercial |
$3,320.28
|
| Rate for Payer: Health EOS Commercial |
$3,212.01
|
| Rate for Payer: HFN Commercial |
$3,320.28
|
| Rate for Payer: Multiplan Commercial |
$2,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,165.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,320.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,768.41
|
| Rate for Payer: Quartz Commercial |
$2,165.40
|
| Rate for Payer: WEA Trust Commercial |
$1,984.95
|
| Rate for Payer: WPS Commercial |
$2,673.19
|
|
|
SONIC ANCHOR KIT 2.5 X 10MM 1910-1272S
|
Facility
OP
|
$3,609.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5917656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.52 |
| Max. Negotiated Rate |
$3,320.28 |
| Rate for Payer: Aetna Commercial |
$3,248.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,103.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,010.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,345.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,804.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,732.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,912.77
|
| Rate for Payer: Cash Price |
$1,082.70
|
| Rate for Payer: Cigna Commercial |
$3,320.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,019.60
|
| Rate for Payer: Health EOS Commercial |
$3,212.01
|
| Rate for Payer: HFN Commercial |
$3,320.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,706.75
|
| Rate for Payer: Multiplan Commercial |
$2,887.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,165.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,320.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,768.41
|
| Rate for Payer: Quartz Commercial |
$2,345.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,165.40
|
| Rate for Payer: WEA Trust Commercial |
$1,984.95
|
| Rate for Payer: WPS Commercial |
$2,673.19
|
|
|
SPACER TAPERED +0MM MODULAR CATHCART 1363-10-000
|
Facility
IP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,275.47 |
| Max. Negotiated Rate |
$2,394.76 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,561.80
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
SPACER TAPERED +0MM MODULAR CATHCART 1363-10-000
|
Facility
OP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$728.84 |
| Max. Negotiated Rate |
$2,394.76 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,238.58
|
| Rate for Payer: Aetna Managed Medicare |
$728.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,691.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,249.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,952.25
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,691.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,561.80
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
SPACER TAPERED -3MM MODULAR CATHCART 1363-08-000
|
Facility
OP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.84 |
| Max. Negotiated Rate |
$2,394.76 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,238.58
|
| Rate for Payer: Aetna Managed Medicare |
$728.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,691.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,249.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,952.25
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,691.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,561.80
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
SPACER TAPERED -3MM MODULAR CATHCART 1363-08-000
|
Facility
IP
|
$2,603.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5520925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.47 |
| Max. Negotiated Rate |
$2,394.76 |
| Rate for Payer: Aetna Commercial |
$2,342.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.59
|
| Rate for Payer: Cash Price |
$780.90
|
| Rate for Payer: Cigna Commercial |
$2,394.76
|
| Rate for Payer: Health EOS Commercial |
$2,316.67
|
| Rate for Payer: HFN Commercial |
$2,394.76
|
| Rate for Payer: Multiplan Commercial |
$2,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.47
|
| Rate for Payer: Quartz Commercial |
$1,561.80
|
| Rate for Payer: WEA Trust Commercial |
$1,431.65
|
| Rate for Payer: WPS Commercial |
$1,928.04
|
|
|
SPACER TAPERED +5MM MODULAR CATHCART 1363-12-000
|
Facility
OP
|
$1,731.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.68 |
| Max. Negotiated Rate |
$1,592.52 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.66
|
| Rate for Payer: Aetna Managed Medicare |
$484.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,125.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.67
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,298.25
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,125.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.60
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
|
SPACER TAPERED +5MM MODULAR CATHCART 1363-12-000
|
Facility
IP
|
$1,731.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6172815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.19 |
| Max. Negotiated Rate |
$1,592.52 |
| Rate for Payer: Aetna Commercial |
$1,557.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.43
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,592.52
|
| Rate for Payer: Health EOS Commercial |
$1,540.59
|
| Rate for Payer: HFN Commercial |
$1,592.52
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.52
|
| Rate for Payer: Quartz Beloit One Network |
$848.19
|
| Rate for Payer: Quartz Commercial |
$1,038.60
|
| Rate for Payer: WEA Trust Commercial |
$952.05
|
| Rate for Payer: WPS Commercial |
$1,282.15
|
|
