|
BELT RECHARGER SMALL INTERSTIM FP9000S
|
Facility
OP
|
$799.00
|
|
| Hospital Charge Code |
5603699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
BELT RECHARGER SMALL INTERSTIM FP9000S
|
Facility
IP
|
$799.00
|
|
| Hospital Charge Code |
5603699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
Benadryl 25 mg Charge
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2958849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Benadryl 25 mg Charge
|
Professional
|
$7.00
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2958849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.06
|
| Rate for Payer: Anthem Medicare Advantage |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.06
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.82
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1.06
|
| Rate for Payer: The Alliance Commercial |
$2.92
|
| Rate for Payer: United Healthcare Medicaid |
$0.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.06
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$2.06
|
|
|
Benadryl 25 mg Charge
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2958849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1,465.68 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.09
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$1,465.68
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$2.06
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
IP
|
$33,311.00
|
|
|
Service Code
|
MS-DRG 725
|
| Min. Negotiated Rate |
$11,982.36 |
| Max. Negotiated Rate |
$33,311.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,982.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,982.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,982.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,982.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,982.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,982.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,197.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,982.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,982.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,982.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,982.36
|
| Rate for Payer: NAPHCARE Commercial |
$17,973.54
|
| Rate for Payer: Quartz Medicare Advantage |
$11,982.36
|
| Rate for Payer: The Alliance Commercial |
$33,311.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,982.36
|
| Rate for Payer: United Healthcare PPO |
$18,838.10
|
| Rate for Payer: Wellcare Medicare |
$11,982.36
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
IP
|
$19,752.00
|
|
|
Service Code
|
MS-DRG 726
|
| Min. Negotiated Rate |
$7,105.08 |
| Max. Negotiated Rate |
$19,752.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,315.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,739.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,152.94
|
| Rate for Payer: Anthem Medicare Advantage |
$7,105.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,105.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,105.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,105.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,380.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,105.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,252.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,105.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,105.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,105.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,105.08
|
| Rate for Payer: NAPHCARE Commercial |
$10,657.62
|
| Rate for Payer: Quartz Medicare Advantage |
$7,105.08
|
| Rate for Payer: The Alliance Commercial |
$19,752.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,105.08
|
| Rate for Payer: United Healthcare PPO |
$11,095.79
|
| Rate for Payer: Wellcare Medicare |
$7,105.08
|
|
|
Benzocaine Top 20% mucous membrane gel [MED]
|
Facility
IP
|
$77.00
|
|
| Hospital Charge Code |
2983117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Benzocaine Top 20% mucous membrane gel [MED]
|
Facility
OP
|
$77.00
|
|
| Hospital Charge Code |
2983117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$21.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.20
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
benzocaine top 20% mucous membrane SPRAY [MED]
|
Facility
IP
|
$109.00
|
|
| Hospital Charge Code |
3331510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
benzocaine top 20% mucous membrane SPRAY [MED]
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
3331510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Benzodiazepine Screen
|
Professional
|
$48.00
|
|
| Hospital Charge Code |
2942885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Benzodiazepine Screen
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
2942885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Benzodiazepine Screen
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
2942885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Benzodiazepines, Quant, Urine
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
4619089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Benzodiazepines, Quant, Urine
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
4619089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$425.68 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.48
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Benzodiazepines, Quant, Urine
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
4619089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$503.49 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$503.49
|
|
|
Benzodiazepines, Urine Confirmation
|
Professional
|
$188.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
983500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$178.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
| Rate for Payer: Health EOS Commercial |
$171.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.60
|
| Rate for Payer: Quartz Beloit One Network |
$82.72
|
| Rate for Payer: Quartz Commercial |
$107.16
|
| Rate for Payer: The Alliance Commercial |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Benzodiazepines, Urine Confirmation
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
983500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Benzodiazepines, Urine Confirmation
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
983500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Aetna Managed Medicare |
$52.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| Rate for Payer: Quartz Medicare Advantage |
$112.80
|
| Rate for Payer: United Healthcare PPO |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Benztropine JW Waste Charge per 1 mg
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
HCPCS J0515 JW
|
| Hospital Charge Code |
5266716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Benztropine JW Waste Charge per 1 mg
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
HCPCS J0515 JW
|
| Hospital Charge Code |
5266716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$33.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$71.40
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Beta 2 Creatinine Urine
|
Professional
|
$125.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2942875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$118.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$113.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Preferred Network Access Commercial |
$118.75
|
| Rate for Payer: Quartz Beloit One Network |
$55.00
|
| Rate for Payer: Quartz Commercial |
$71.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
Beta 2 Creatinine Urine
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2942875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Beta 2 Creatinine Urine
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2942875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$500.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$93.75
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
