|
SPOT SOBOL LARGE #SP-06L
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
2971385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
SPOT SOBOL LARGE #SP-06L
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
2971385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$26,029.00
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$9,362.97 |
| Max. Negotiated Rate |
$26,029.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,362.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,350.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,598.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,819.66
|
| Rate for Payer: Anthem Medicare Advantage |
$9,362.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,362.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,362.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,362.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,451.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,362.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,856.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,362.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,362.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,362.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,362.97
|
| Rate for Payer: NAPHCARE Commercial |
$14,044.46
|
| Rate for Payer: Quartz Medicare Advantage |
$9,362.97
|
| Rate for Payer: The Alliance Commercial |
$26,029.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,362.97
|
| Rate for Payer: United Healthcare PPO |
$14,680.03
|
| Rate for Payer: Wellcare Medicare |
$9,362.97
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
|
IP
|
$19,173.00
|
|
|
Service Code
|
MSDRG 538
|
| Min. Negotiated Rate |
$6,896.61 |
| Max. Negotiated Rate |
$19,173.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,896.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,895.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,417.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,847.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6,896.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,896.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,896.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,896.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,041.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,896.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,827.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,896.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,896.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,896.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,896.61
|
| Rate for Payer: NAPHCARE Commercial |
$10,344.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6,896.61
|
| Rate for Payer: The Alliance Commercial |
$19,173.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,896.61
|
| Rate for Payer: United Healthcare PPO |
$10,764.85
|
| Rate for Payer: Wellcare Medicare |
$6,896.61
|
|
|
SPRAY TIP PROGEL 16CM EXTENDED PGEN005-06
|
Facility
|
IP
|
$1,330.00
|
|
| Hospital Charge Code |
4595031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.70 |
| Max. Negotiated Rate |
$1,223.60 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SPRAY TIP PROGEL 16CM EXTENDED PGEN005-06
|
Facility
|
OP
|
$1,330.00
|
|
| Hospital Charge Code |
4595031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$5,320.00 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Aetna Managed Medicare |
$372.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$864.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.27
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$864.50
|
| Rate for Payer: Quartz Medicare Advantage |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$5,320.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SPRAY TIP PROGEL 29CM EXTENDED PGEN005-11
|
Facility
|
IP
|
$1,330.00
|
|
| Hospital Charge Code |
4595030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.70 |
| Max. Negotiated Rate |
$1,223.60 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
SPRAY TIP PROGEL 29CM EXTENDED PGEN005-11
|
Facility
|
OP
|
$1,330.00
|
|
| Hospital Charge Code |
4595030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$5,320.00 |
| Rate for Payer: Aetna Commercial |
$1,197.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,143.80
|
| Rate for Payer: Aetna Managed Medicare |
$372.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$864.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.90
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.27
|
| Rate for Payer: Health EOS Commercial |
$1,183.70
|
| Rate for Payer: HFN Commercial |
$1,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$1,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$798.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$651.70
|
| Rate for Payer: Quartz Commercial |
$864.50
|
| Rate for Payer: Quartz Medicare Advantage |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$5,320.00
|
| Rate for Payer: WEA Trust Commercial |
$731.50
|
| Rate for Payer: WPS Commercial |
$985.13
|
|
|
Sprotte Spinal Ndl 24Ga x 150Mm
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
3101770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Sprotte Spinal Ndl 24Ga x 150Mm
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
3101770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Sprotte Spinal Ndl 24Ga x 90Mm
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3101769
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Sprotte Spinal Ndl 24Ga x 90Mm
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3101769
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$63.00
|
| Rate for Payer: The Alliance Commercial |
$420.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Sprotte Spinal Ndl 25Ga x 4-7/8 7080""
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
3101771
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$64.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$137.40
|
| Rate for Payer: The Alliance Commercial |
$916.00
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
Sprotte Spinal Ndl 25Ga x 4-7/8 7080""
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
3101771
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
Sputum Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Sputum Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Sputum Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633903
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
SRP Autoabs
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
SRP Autoabs
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
SRP Autoabs
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
SRP Autoantibodies
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5128609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
SRP Autoantibodies
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5128609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
SRP Autoantibodies
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5128609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
SRYINGE 10ML MEDALLION MSS111-PR
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
6207021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| 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
|
|
|
SRYINGE 10ML MEDALLION MSS111-PR
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
6207021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| 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 |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| 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: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| 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 |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
