|
zzCV Venogram Cava Superior
|
Facility
OP
|
$6,544.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
629674
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$8,217.12 |
| Rate for Payer: Aetna Commercial |
$5,889.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,627.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,253.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,141.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,468.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$1,963.20
|
| Rate for Payer: Cash Price |
$1,963.20
|
| Rate for Payer: Cigna Commercial |
$6,020.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$5,824.16
|
| Rate for Payer: HFN Commercial |
$6,020.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$5,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,020.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,206.56
|
| Rate for Payer: Quartz Commercial |
$4,253.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$8,217.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$3,599.20
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$4,847.14
|
|
|
zzEEG, AWAKE AND ASLEEP 9581926
|
Professional
|
$401.00
|
|
|
Service Code
|
CPT 95819 26
|
| Hospital Charge Code |
3015467
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.09 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Aetna Managed Medicare |
$54.09
|
| Rate for Payer: Anthem Medicare Advantage |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.09
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$380.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.09
|
| Rate for Payer: Health EOS Commercial |
$364.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.09
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$380.95
|
| Rate for Payer: Quartz Beloit One Network |
$176.44
|
| Rate for Payer: Quartz Commercial |
$228.57
|
| Rate for Payer: Quartz Medicare Advantage |
$54.09
|
| Rate for Payer: The Alliance Commercial |
$135.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.09
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$216.36
|
|
|
zzEEG, OVER 1 HOUR 9581326
|
Professional
|
$461.00
|
|
|
Service Code
|
CPT 95813 26
|
| Hospital Charge Code |
6121638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.74 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Quartz Medicare Advantage |
$81.74
|
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$81.74
|
| Rate for Payer: Anthem Medicare Advantage |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.74
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$437.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.74
|
| Rate for Payer: Health EOS Commercial |
$419.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.74
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Preferred Network Access Commercial |
$437.95
|
| Rate for Payer: Quartz Beloit One Network |
$202.84
|
| Rate for Payer: Quartz Commercial |
$262.77
|
| Rate for Payer: The Alliance Commercial |
$204.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$326.96
|
|
|
zzESOPHAGEAL ABLATION (HALO PROCEDURE)
|
Facility
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
2960020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,232.35 |
| Max. Negotiated Rate |
$2,313.80 |
| Rate for Payer: Aetna Commercial |
$2,263.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.95
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cigna Commercial |
$2,313.80
|
| Rate for Payer: Health EOS Commercial |
$2,238.35
|
| Rate for Payer: HFN Commercial |
$2,313.80
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,509.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,313.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.35
|
| Rate for Payer: Quartz Commercial |
$1,509.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.25
|
| Rate for Payer: WPS Commercial |
$1,862.86
|
|
|
zzESOPHAGEAL ABLATION (HALO PROCEDURE)
|
Facility
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
2960020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$636.03 |
| Max. Negotiated Rate |
$13,185.36 |
| Rate for Payer: Aetna Commercial |
$2,263.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,162.90
|
| Rate for Payer: Aetna Managed Medicare |
$903.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.36
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cigna Commercial |
$2,313.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.36
|
| Rate for Payer: Health EOS Commercial |
$2,238.35
|
| Rate for Payer: HFN Commercial |
$2,313.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.36
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,313.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.35
|
| Rate for Payer: Quartz Commercial |
$1,634.75
|
| Rate for Payer: Quartz Medicare Advantage |
$903.36
|
| Rate for Payer: The Alliance Commercial |
$13,185.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.36
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$1,383.25
|
| Rate for Payer: Wellcare Medicare |
$903.36
|
| Rate for Payer: WPS Commercial |
$1,862.86
|
|
|
zzFlu A/B
|
Professional
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$174.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.55
|
| Rate for Payer: Anthem Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.55
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.55
|
| Rate for Payer: Health EOS Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.96
|
| Rate for Payer: Quartz Commercial |
$104.88
|
| Rate for Payer: Quartz Medicare Advantage |
$16.55
|
| Rate for Payer: The Alliance Commercial |
$65.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$72.82
|
|
|
zzFlu A/B
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.47
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.55
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.55
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.82
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$119.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16.55
|
| Rate for Payer: The Alliance Commercial |
$736.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare PPO |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
zzFlu A/B
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$169.28 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$110.40
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Professional
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$56.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$63.32
|
|
|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Facility
OP
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$283.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$274.12
|
| Rate for Payer: HFN Commercial |
$283.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$283.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$150.92
|
| Rate for Payer: Quartz Commercial |
$200.20
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$1,232.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$283.36 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.24
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$283.36
|
| Rate for Payer: Health EOS Commercial |
$274.12
|
| Rate for Payer: HFN Commercial |
$283.36
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: NAPHCARE Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$283.36
|
| Rate for Payer: Quartz Beloit One Network |
$150.92
|
| Rate for Payer: Quartz Commercial |
$184.80
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
zzKNEE MANIPULATION
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
zzKNEE MANIPULATION
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
zzOcc Bld Stl, 3 Cards
|
Professional
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna Commercial |
$198.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$4.23
|
| Rate for Payer: Anthem Medicare Advantage |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.23
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$198.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.23
|
| Rate for Payer: Health EOS Commercial |
$190.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: Preferred Network Access Commercial |
$198.55
|
| Rate for Payer: Quartz Beloit One Network |
$91.96
|
| Rate for Payer: Quartz Commercial |
$119.13
|
| Rate for Payer: Quartz Medicare Advantage |
$4.23
|
| Rate for Payer: The Alliance Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$18.61
|
|
|
zzOcc Bld Stl, 3 Cards
|
Facility
IP
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
zzOcc Bld Stl, 3 Cards
|
Facility
OP
|
$209.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
979905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$4.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.02
|
| Rate for Payer: Anthem Medicaid |
$4.26
|
| Rate for Payer: Anthem Medicare Advantage |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.23
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.23
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.23
|
| Rate for Payer: Managed Health Services Medicaid |
$4.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.34
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.26
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$135.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.23
|
| Rate for Payer: The Alliance Commercial |
$836.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: United Healthcare PPO |
$156.75
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: Wellcare Medicare |
$4.23
|
| Rate for Payer: WMAP Medicaid |
$4.26
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
zz.Oligoclonal Bands CSF
|
Facility
IP
|
$343.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
1114847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.07 |
| Max. Negotiated Rate |
$315.56 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.79
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$315.56
|
| Rate for Payer: Health EOS Commercial |
$305.27
|
| Rate for Payer: HFN Commercial |
$315.56
|
| Rate for Payer: Multiplan Commercial |
$274.40
|
| Rate for Payer: NAPHCARE Commercial |
$205.80
|
| Rate for Payer: Preferred Network Access Commercial |
$315.56
|
| Rate for Payer: Quartz Beloit One Network |
$168.07
|
| Rate for Payer: Quartz Commercial |
$205.80
|
| Rate for Payer: WEA Trust Commercial |
$188.65
|
| Rate for Payer: WPS Commercial |
$254.06
|
|
|
zz.Oligoclonal Bands CSF
|
Facility
OP
|
$343.00
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
1114847
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.98
|
| Rate for Payer: Aetna Managed Medicare |
$27.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.47
|
| Rate for Payer: Anthem Medicaid |
$28.28
|
| Rate for Payer: Anthem Medicare Advantage |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.39
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cash Price |
$102.90
|
| Rate for Payer: Cigna Commercial |
$315.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.28
|
| Rate for Payer: Dean Health Medicaid |
$28.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.39
|
| Rate for Payer: Health EOS Commercial |
$305.27
|
| Rate for Payer: HFN Commercial |
$315.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.39
|
| Rate for Payer: Managed Health Services Medicaid |
$29.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.39
|
| Rate for Payer: Multiplan Commercial |
$274.40
|
| Rate for Payer: NAPHCARE Commercial |
$41.08
|
| Rate for Payer: Preferred Network Access Commercial |
$315.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.28
|
| Rate for Payer: Quartz Beloit One Network |
$168.07
|
| Rate for Payer: Quartz Commercial |
$222.95
|
| Rate for Payer: Quartz Medicare Advantage |
$27.39
|
| Rate for Payer: The Alliance Commercial |
$1,372.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.39
|
| Rate for Payer: United Healthcare PPO |
$257.25
|
| Rate for Payer: WEA Trust Commercial |
$188.65
|
| Rate for Payer: Wellcare Medicare |
$27.39
|
| Rate for Payer: WMAP Medicaid |
$28.28
|
| Rate for Payer: WPS Commercial |
$254.06
|
|
|
zzPOLYSOMNOGRAPHY W/CPAP 9581126
|
Professional
|
$2,484.00
|
|
|
Service Code
|
CPT 95811 26
|
| Hospital Charge Code |
3015465
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.14 |
| Max. Negotiated Rate |
$2,359.80 |
| Rate for Payer: Aetna Commercial |
$2,359.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,136.24
|
| Rate for Payer: Aetna Managed Medicare |
$118.14
|
| Rate for Payer: Anthem Medicare Advantage |
$118.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.14
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna Commercial |
$2,359.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.14
|
| Rate for Payer: Health EOS Commercial |
$2,260.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.14
|
| Rate for Payer: Multiplan Commercial |
$1,987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,359.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.96
|
| Rate for Payer: Quartz Commercial |
$1,415.88
|
| Rate for Payer: Quartz Medicare Advantage |
$118.14
|
| Rate for Payer: The Alliance Commercial |
$295.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.14
|
| Rate for Payer: WEA Trust Commercial |
$1,366.20
|
| Rate for Payer: WPS Commercial |
$472.56
|
|
|
zzzABDOMINAL AORTIC ANEURYSM, ENDOVASCULAR REPAIR
|
Facility
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,873.81 |
| Max. Negotiated Rate |
$14,783.48 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$9,641.40
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
zzzABDOMINAL AORTIC ANEURYSM, ENDOVASCULAR REPAIR
|
Facility
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,499.32 |
| Max. Negotiated Rate |
$64,276.00 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Aetna Managed Medicare |
$4,499.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,444.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,034.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,713.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,992.21
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,051.75
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$10,444.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9,641.40
|
| Rate for Payer: The Alliance Commercial |
$64,276.00
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
zzzABDOMINAL HYSTERECTOMY W/ BILATERAL SALPINGO OOPHERECTOMY, TOTAL
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzABDOMINAL HYSTERECTOMY W/ BILATERAL SALPINGO OOPHERECTOMY, TOTAL
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960518
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
zzzAMPUTATION, ANKLE
|
Facility
OP
|
$1,632.00
|
|
| Hospital Charge Code |
2959786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.96 |
| Max. Negotiated Rate |
$6,528.00 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,403.52
|
| Rate for Payer: Aetna Managed Medicare |
$456.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$783.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.27
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,224.00
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$1,060.80
|
| Rate for Payer: Quartz Medicare Advantage |
$979.20
|
| Rate for Payer: The Alliance Commercial |
$6,528.00
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
|
zzzAMPUTATION, ANKLE
|
Facility
IP
|
$1,632.00
|
|
| Hospital Charge Code |
2959786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.68 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,468.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$864.96
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cigna Commercial |
$1,501.44
|
| Rate for Payer: Health EOS Commercial |
$1,452.48
|
| Rate for Payer: HFN Commercial |
$1,501.44
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: NAPHCARE Commercial |
$979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.44
|
| Rate for Payer: Quartz Beloit One Network |
$799.68
|
| Rate for Payer: Quartz Commercial |
$979.20
|
| Rate for Payer: WEA Trust Commercial |
$897.60
|
| Rate for Payer: WPS Commercial |
$1,208.82
|
|
