|
SLOTTED PLATE HOFFMAN LIMB 4934-1-060
|
Facility
|
IP
|
$1,583.00
|
|
| Hospital Charge Code |
6001646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$806.70 |
| Max. Negotiated Rate |
$1,514.61 |
| Rate for Payer: Aetna Commercial |
$1,481.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,415.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.55
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,514.61
|
| Rate for Payer: Health EOS Commercial |
$1,465.22
|
| Rate for Payer: HFN Commercial |
$1,514.61
|
| Rate for Payer: Multiplan Commercial |
$1,317.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.61
|
| Rate for Payer: Quartz Beloit One Network |
$806.70
|
| Rate for Payer: Quartz Commercial |
$987.79
|
| Rate for Payer: WEA Trust Commercial |
$905.48
|
| Rate for Payer: WPS Commercial |
$1,219.38
|
|
|
SLP Cognitive Function Intervention Chrg
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
5344656
|
|
Hospital Revenue Code
|
440
|
| 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
|
|
|
SLP Cognitive Function Intervention Chrg
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
5344656
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$362.96 |
| 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 |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| 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 |
$210.08
|
| 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: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Facility
|
IP
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$7,615.46 |
| Max. Negotiated Rate |
$14,298.42 |
| Rate for Payer: Aetna Commercial |
$13,987.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,237.13
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,298.42
|
| Rate for Payer: Health EOS Commercial |
$13,832.17
|
| Rate for Payer: HFN Commercial |
$14,298.42
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: Preferred Network Access Commercial |
$14,298.42
|
| Rate for Payer: Quartz Beloit One Network |
$7,615.46
|
| Rate for Payer: Quartz Commercial |
$9,325.06
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Professional
|
Both
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$6,838.37 |
| Max. Negotiated Rate |
$29,668.71 |
| Rate for Payer: Aetna Commercial |
$14,764.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,764.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,770.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,325.06
|
| Rate for Payer: Health EOS Commercial |
$14,143.00
|
| Rate for Payer: HFN Commercial |
$14,764.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,668.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,668.71
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: Preferred Network Access Commercial |
$14,764.67
|
| Rate for Payer: Quartz Beloit One Network |
$6,838.37
|
| Rate for Payer: Quartz Commercial |
$8,858.80
|
| Rate for Payer: The Alliance Commercial |
$7,770.88
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
Sm-153 Lexidronam(per 50 mCi)
|
Facility
|
OP
|
$14,944.00
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
1486846
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3,286.19 |
| Max. Negotiated Rate |
$14,298.42 |
| Rate for Payer: Aetna Commercial |
$13,987.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,365.91
|
| Rate for Payer: Aetna Managed Medicare |
$3,286.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,102.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,770.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,460.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,286.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,237.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,286.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,286.19
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cash Price |
$4,483.20
|
| Rate for Payer: Cigna Commercial |
$14,298.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,286.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,697.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,286.19
|
| Rate for Payer: Health EOS Commercial |
$13,832.17
|
| Rate for Payer: HFN Commercial |
$14,298.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,224.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,286.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,286.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,286.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,286.19
|
| Rate for Payer: Multiplan Commercial |
$12,433.41
|
| Rate for Payer: NAPHCARE Commercial |
$4,929.29
|
| Rate for Payer: Preferred Network Access Commercial |
$14,298.42
|
| Rate for Payer: Quartz Beloit One Network |
$7,615.46
|
| Rate for Payer: Quartz Commercial |
$10,102.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,286.19
|
| Rate for Payer: The Alliance Commercial |
$13,144.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,286.19
|
| Rate for Payer: WEA Trust Commercial |
$8,547.97
|
| Rate for Payer: Wellcare Medicare |
$3,286.19
|
| Rate for Payer: WPS Commercial |
$11,511.36
|
|
|
SMA Carrier Screen
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
3805565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$689.49 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$844.27
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
SMA Carrier Screen
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
3805565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$914.63
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$1,055.34
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
SMA Carrier Screen
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
3805565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,336.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$703.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$1,280.48
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$619.13
|
| Rate for Payer: Quartz Commercial |
$802.06
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
SMA Diagnostic Test
|
Professional
|
Both
|
$1,164.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4622663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$1,150.03 |
| Rate for Payer: Aetna Commercial |
$1,150.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,150.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$605.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$1,101.61
|
| Rate for Payer: HFN Commercial |
$1,150.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.03
|
| Rate for Payer: Quartz Beloit One Network |
$532.65
|
| Rate for Payer: Quartz Commercial |
$690.02
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
SMA Diagnostic Test
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4622663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$786.86
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
SMA Diagnostic Test
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4622663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$593.17 |
| Max. Negotiated Rate |
$1,113.72 |
| Rate for Payer: Aetna Commercial |
$1,089.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,041.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.60
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,113.72
|
| Rate for Payer: Health EOS Commercial |
$1,077.40
|
| Rate for Payer: HFN Commercial |
$1,113.72
|
| Rate for Payer: Multiplan Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,113.72
|
| Rate for Payer: Quartz Beloit One Network |
$593.17
|
| Rate for Payer: Quartz Commercial |
$726.34
|
| Rate for Payer: WEA Trust Commercial |
$665.81
|
| Rate for Payer: WPS Commercial |
$896.63
|
|
|
Small black foam
|
Facility
|
OP
|
$642.00
|
|
| Hospital Charge Code |
3006911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$186.95 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$186.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$500.76
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$400.61
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$433.99
|
| Rate for Payer: Quartz Medicare Advantage |
$400.61
|
| Rate for Payer: The Alliance Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
Small black foam
|
Facility
|
IP
|
$642.00
|
|
| Hospital Charge Code |
3006911
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$327.16 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$400.61
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
SMALL BOWEL RESECTION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
SMALL BOWEL RESECTION
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$8,077.76
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)
|
Facility
|
OP
|
$8,077.76
|
|
|
Service Code
|
CPT 44366
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$8,077.76
|
|
|
Service Code
|
CPT 44364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
|
|
Small Joint 20600 - Admin Intra-articular Injection Charge
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3475535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$136.84 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$30.41
|
| Rate for Payer: Anthem Medicare Advantage |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.41
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.41
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.41
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$45.61
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$30.41
|
| Rate for Payer: The Alliance Commercial |
$129.24
|
| Rate for Payer: United Healthcare Medicaid |
$40.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.41
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$136.84
|
|
|
Small Joint 20600 - Admin Intra-articular Injection Charge
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3475535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$246.11 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Small Joint 20600 - Admin Intra-articular Injection Charge
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3475535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Small joint or bursa w/ultrasound guidance 20604
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
4500691
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$1,406.91 |
| Rate for Payer: Aetna Commercial |
$1,406.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$38.39
|
| Rate for Payer: Anthem Medicare Advantage |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.39
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,406.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.39
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,406.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.39
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$57.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.91
|
| Rate for Payer: Quartz Beloit One Network |
$651.62
|
| Rate for Payer: Quartz Commercial |
$844.15
|
| Rate for Payer: Quartz Medicare Advantage |
$38.39
|
| Rate for Payer: The Alliance Commercial |
$163.14
|
| Rate for Payer: United Healthcare Medicaid |
$57.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.39
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$172.74
|
|
|
Small joint w/ultrasound guidance 2060450
|
Professional
|
Both
|
$2,845.00
|
|
|
Service Code
|
CPT 20604 50
|
| Hospital Charge Code |
5388753
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.84 |
| Max. Negotiated Rate |
$2,810.86 |
| Rate for Payer: Aetna Commercial |
$2,810.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,544.57
|
| Rate for Payer: Cash Price |
$853.50
|
| Rate for Payer: Cash Price |
$853.50
|
| Rate for Payer: Cash Price |
$853.50
|
| Rate for Payer: Cigna Commercial |
$2,810.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,775.28
|
| Rate for Payer: Health EOS Commercial |
$2,692.51
|
| Rate for Payer: HFN Commercial |
$2,810.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.24
|
| Rate for Payer: Multiplan Commercial |
$2,367.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,810.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.87
|
| Rate for Payer: Quartz Commercial |
$1,686.52
|
| Rate for Payer: The Alliance Commercial |
$1,479.40
|
| Rate for Payer: United Healthcare Medicaid |
$57.84
|
| Rate for Payer: WEA Trust Commercial |
$1,627.34
|
| Rate for Payer: WPS Commercial |
$2,191.50
|
|
|
Small white foam
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
3006896
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
