|
ABLATOR APOLLO ASPIRATING ARTHREX AR-9821
|
Facility
|
IP
|
$2,896.00
|
|
| Hospital Charge Code |
5206680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.04 |
| Max. Negotiated Rate |
$2,664.32 |
| Rate for Payer: Aetna Commercial |
$2,606.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,490.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,534.88
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$2,664.32
|
| Rate for Payer: Health EOS Commercial |
$2,577.44
|
| Rate for Payer: HFN Commercial |
$2,664.32
|
| Rate for Payer: Multiplan Commercial |
$2,316.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,737.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,664.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.04
|
| Rate for Payer: Quartz Commercial |
$1,737.60
|
| Rate for Payer: WEA Trust Commercial |
$1,592.80
|
| Rate for Payer: WPS Commercial |
$2,145.07
|
|
|
ABLATOR APOLLO I90 ASPIRATING ARTHREX AR-9831
|
Facility
|
OP
|
$2,221.00
|
|
| Hospital Charge Code |
6234163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.88 |
| Max. Negotiated Rate |
$8,884.00 |
| Rate for Payer: Aetna Commercial |
$1,998.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,910.06
|
| Rate for Payer: Aetna Managed Medicare |
$621.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,066.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.13
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cigna Commercial |
$2,043.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.87
|
| Rate for Payer: Health EOS Commercial |
$1,976.69
|
| Rate for Payer: HFN Commercial |
$2,043.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.75
|
| Rate for Payer: Multiplan Commercial |
$1,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,043.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.29
|
| Rate for Payer: Quartz Commercial |
$1,443.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.60
|
| Rate for Payer: The Alliance Commercial |
$8,884.00
|
| Rate for Payer: WEA Trust Commercial |
$1,221.55
|
| Rate for Payer: WPS Commercial |
$1,645.09
|
|
|
ABLATOR APOLLO I90 ASPIRATING ARTHREX AR-9831
|
Facility
|
IP
|
$2,221.00
|
|
| Hospital Charge Code |
6234163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.29 |
| Max. Negotiated Rate |
$2,043.32 |
| Rate for Payer: Aetna Commercial |
$1,998.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,910.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.13
|
| Rate for Payer: Cash Price |
$666.30
|
| Rate for Payer: Cigna Commercial |
$2,043.32
|
| Rate for Payer: Health EOS Commercial |
$1,976.69
|
| Rate for Payer: HFN Commercial |
$2,043.32
|
| Rate for Payer: Multiplan Commercial |
$1,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,043.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.29
|
| Rate for Payer: Quartz Commercial |
$1,332.60
|
| Rate for Payer: WEA Trust Commercial |
$1,221.55
|
| Rate for Payer: WPS Commercial |
$1,645.09
|
|
|
ABLATOR APOLLO RF ASPIRATING 50DEG MULTI-PORT AR-9815
|
Facility
|
IP
|
$2,432.00
|
|
| Hospital Charge Code |
5414730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.68 |
| Max. Negotiated Rate |
$2,237.44 |
| Rate for Payer: Aetna Commercial |
$2,188.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,091.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,288.96
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$2,237.44
|
| Rate for Payer: Health EOS Commercial |
$2,164.48
|
| Rate for Payer: HFN Commercial |
$2,237.44
|
| Rate for Payer: Multiplan Commercial |
$1,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,237.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.68
|
| Rate for Payer: Quartz Commercial |
$1,459.20
|
| Rate for Payer: WEA Trust Commercial |
$1,337.60
|
| Rate for Payer: WPS Commercial |
$1,801.38
|
|
|
ABLATOR APOLLO RF ASPIRATING 50DEG MULTI-PORT AR-9815
|
Facility
|
OP
|
$2,432.00
|
|
| Hospital Charge Code |
5414730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.96 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Aetna Commercial |
$2,188.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,091.52
|
| Rate for Payer: Aetna Managed Medicare |
$680.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,580.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,216.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,167.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,288.96
|
| Rate for Payer: Cash Price |
$729.60
|
| Rate for Payer: Cigna Commercial |
$2,237.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,360.95
|
| Rate for Payer: Health EOS Commercial |
$2,164.48
|
| Rate for Payer: HFN Commercial |
$2,237.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,824.00
|
| Rate for Payer: Multiplan Commercial |
$1,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,237.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.68
|
| Rate for Payer: Quartz Commercial |
$1,580.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,459.20
|
| Rate for Payer: The Alliance Commercial |
$9,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,337.60
|
| Rate for Payer: WPS Commercial |
$1,801.38
|
|
|
ABLATOR APOLLO RF ASPIRATING 90DEG MULTI-PORT AR-9811
|
Facility
|
IP
|
$3,010.00
|
|
| Hospital Charge Code |
5074888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,474.90 |
| Max. Negotiated Rate |
$2,769.20 |
| Rate for Payer: Aetna Commercial |
$2,709.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,588.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.30
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$2,769.20
|
| Rate for Payer: Health EOS Commercial |
$2,678.90
|
| Rate for Payer: HFN Commercial |
$2,769.20
|
| Rate for Payer: Multiplan Commercial |
$2,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,806.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,769.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,474.90
|
| Rate for Payer: Quartz Commercial |
$1,806.00
|
| Rate for Payer: WEA Trust Commercial |
$1,655.50
|
| Rate for Payer: WPS Commercial |
$2,229.51
|
|
|
ABLATOR APOLLO RF ASPIRATING 90DEG MULTI-PORT AR-9811
|
Facility
|
OP
|
$3,010.00
|
|
| Hospital Charge Code |
5074888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.80 |
| Max. Negotiated Rate |
$12,040.00 |
| Rate for Payer: Aetna Commercial |
$2,709.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,588.60
|
| Rate for Payer: Aetna Managed Medicare |
$842.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,956.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,505.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,444.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,595.30
|
| Rate for Payer: Cash Price |
$903.00
|
| Rate for Payer: Cigna Commercial |
$2,769.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,684.40
|
| Rate for Payer: Health EOS Commercial |
$2,678.90
|
| Rate for Payer: HFN Commercial |
$2,769.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,257.50
|
| Rate for Payer: Multiplan Commercial |
$2,408.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,806.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,769.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,474.90
|
| Rate for Payer: Quartz Commercial |
$1,956.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,806.00
|
| Rate for Payer: The Alliance Commercial |
$12,040.00
|
| Rate for Payer: WEA Trust Commercial |
$1,655.50
|
| Rate for Payer: WPS Commercial |
$2,229.51
|
|
|
ABLATOR APOLLO RF J50 ASPIRATING 50DEG AR-9845
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
5831630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$715.96 |
| Max. Negotiated Rate |
$10,228.00 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Aetna Managed Medicare |
$715.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,662.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.90
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,917.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,662.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,534.20
|
| Rate for Payer: The Alliance Commercial |
$10,228.00
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
ABLATOR APOLLO RF J50 ASPIRATING 50DEG AR-9845
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
5831630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,252.93 |
| Max. Negotiated Rate |
$2,352.44 |
| Rate for Payer: Aetna Commercial |
$2,301.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,355.21
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,352.44
|
| Rate for Payer: Health EOS Commercial |
$2,275.73
|
| Rate for Payer: HFN Commercial |
$2,352.44
|
| Rate for Payer: Multiplan Commercial |
$2,045.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,534.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,352.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.93
|
| Rate for Payer: Quartz Commercial |
$1,534.20
|
| Rate for Payer: WEA Trust Commercial |
$1,406.35
|
| Rate for Payer: WPS Commercial |
$1,893.97
|
|
|
ABLATOR APOLLO RF NON-ASPIRATING HOOK AR-9825
|
Facility
|
IP
|
$2,368.00
|
|
| Hospital Charge Code |
5804228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.32 |
| Max. Negotiated Rate |
$2,178.56 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,036.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,420.80
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
ABLATOR APOLLO RF NON-ASPIRATING HOOK AR-9825
|
Facility
|
OP
|
$2,368.00
|
|
| Hospital Charge Code |
5804228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.04 |
| Max. Negotiated Rate |
$9,472.00 |
| Rate for Payer: Aetna Commercial |
$2,131.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,036.48
|
| Rate for Payer: Aetna Managed Medicare |
$663.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,539.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,184.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,136.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.04
|
| Rate for Payer: Cash Price |
$710.40
|
| Rate for Payer: Cigna Commercial |
$2,178.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,325.13
|
| Rate for Payer: Health EOS Commercial |
$2,107.52
|
| Rate for Payer: HFN Commercial |
$2,178.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,776.00
|
| Rate for Payer: Multiplan Commercial |
$1,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.32
|
| Rate for Payer: Quartz Commercial |
$1,539.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,420.80
|
| Rate for Payer: The Alliance Commercial |
$9,472.00
|
| Rate for Payer: WEA Trust Commercial |
$1,302.40
|
| Rate for Payer: WPS Commercial |
$1,753.98
|
|
|
ABO/Rh Cord
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.59
|
| Rate for Payer: Anthem Medicaid |
$3.09
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.44
|
| Rate for Payer: Dean Health Medicaid |
$3.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicaid |
$3.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.09
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WMAP Medicaid |
$3.09
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
ABO/Rh Cord
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
ABO/Rh Heel
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3154817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.92 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$64.80
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
ABO/Rh Heel
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
3154817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$97.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.59
|
| Rate for Payer: Anthem Medicaid |
$3.09
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$99.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.44
|
| Rate for Payer: Dean Health Medicaid |
$3.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$96.12
|
| Rate for Payer: HFN Commercial |
$99.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicaid |
$3.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$99.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.09
|
| Rate for Payer: Quartz Beloit One Network |
$52.92
|
| Rate for Payer: Quartz Commercial |
$70.20
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WMAP Medicaid |
$3.09
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$21,555.00
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$7,753.46 |
| Max. Negotiated Rate |
$21,555.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,753.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,784.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,864.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,222.40
|
| Rate for Payer: Anthem Medicare Advantage |
$7,753.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,753.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,753.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,753.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,567.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,753.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,574.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,753.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,753.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,753.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,753.46
|
| Rate for Payer: NAPHCARE Commercial |
$11,630.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7,753.46
|
| Rate for Payer: The Alliance Commercial |
$21,555.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,753.46
|
| Rate for Payer: United Healthcare PPO |
$12,125.06
|
| Rate for Payer: Wellcare Medicare |
$7,753.46
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$26,619.00
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$9,575.28 |
| Max. Negotiated Rate |
$26,619.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,575.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,575.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,575.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,575.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,575.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,575.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,289.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,575.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,575.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,575.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,575.28
|
| Rate for Payer: NAPHCARE Commercial |
$14,362.92
|
| Rate for Payer: Quartz Medicare Advantage |
$9,575.28
|
| Rate for Payer: The Alliance Commercial |
$26,619.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,575.28
|
| Rate for Payer: United Healthcare PPO |
$15,017.05
|
| Rate for Payer: Wellcare Medicare |
$9,575.28
|
|
|
Abrasion Treatment of Skin 15780
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
CPT 15780
|
| Hospital Charge Code |
4524816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$561.44 |
| Max. Negotiated Rate |
$2,240.39 |
| Rate for Payer: Aetna Commercial |
$1,212.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,212.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$903.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.60
|
| Rate for Payer: Health EOS Commercial |
$1,161.16
|
| Rate for Payer: HFN Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,240.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,240.39
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.20
|
| Rate for Payer: Quartz Beloit One Network |
$561.44
|
| Rate for Payer: Quartz Commercial |
$727.32
|
| Rate for Payer: The Alliance Commercial |
$638.00
|
| Rate for Payer: United Healthcare Medicaid |
$903.98
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
Abraxane 1 mg Charge
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.71
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.49
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.71
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$34.28
|
|
|
Abraxane 1 mg Charge
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Abraxane 1 mg Charge
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$57.18 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$14.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.00
|
| Rate for Payer: Anthem Medicare Advantage |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.29
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.29
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.29
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.44
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$14.29
|
| Rate for Payer: The Alliance Commercial |
$57.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.29
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: Wellcare Medicare |
$14.29
|
| Rate for Payer: WPS Commercial |
$34.28
|
|
|
Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6242640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.46 |
| Max. Negotiated Rate |
$325.68 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$212.40
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6242640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$99.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.10
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$230.10
|
| Rate for Payer: Quartz Medicare Advantage |
$212.40
|
| Rate for Payer: The Alliance Commercial |
$1,416.00
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6242640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.76 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$336.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.40
|
| Rate for Payer: Health EOS Commercial |
$322.14
|
| Rate for Payer: HFN Commercial |
$336.30
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$336.30
|
| Rate for Payer: Quartz Beloit One Network |
$155.76
|
| Rate for Payer: Quartz Commercial |
$201.78
|
| Rate for Payer: The Alliance Commercial |
$177.00
|
| Rate for Payer: United Healthcare Medicaid |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Abrysvo RSV vaccine preF A-preF B, recombinant 90678
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6224208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.72 |
| Max. Negotiated Rate |
$321.10 |
| Rate for Payer: Aetna Commercial |
$321.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$290.68
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$321.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.80
|
| Rate for Payer: Health EOS Commercial |
$307.58
|
| Rate for Payer: HFN Commercial |
$321.10
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.10
|
| Rate for Payer: Quartz Beloit One Network |
$148.72
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: The Alliance Commercial |
$169.00
|
| Rate for Payer: United Healthcare Medicaid |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$185.90
|
| Rate for Payer: WPS Commercial |
$250.36
|
|
