|
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
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: 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 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 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: 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 |
$473.48 |
| 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 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: 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: 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 |
$473.48 |
| 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 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: 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 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: 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
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$21,555.00
|
|
|
Service Code
|
MS-DRG 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
|
MS-DRG 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
|
$1,276.00
|
|
|
Service Code
|
CPT 15780
|
| Hospital Charge Code |
4524816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$561.44 |
| Max. Negotiated Rate |
$2,834.64 |
| Rate for Payer: Aetna Commercial |
$1,212.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Aetna Managed Medicare |
$629.92
|
| Rate for Payer: Anthem Medicare Advantage |
$629.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$629.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$629.92
|
| 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 |
$638.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.92
|
| Rate for Payer: Health EOS Commercial |
$1,161.16
|
| 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: Independent Care Health Plan Medicare |
$629.92
|
| 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: Quartz Medicare Advantage |
$629.92
|
| Rate for Payer: The Alliance Commercial |
$2,677.16
|
| Rate for Payer: United Healthcare Medicaid |
$903.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$629.92
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$2,834.64
|
|
|
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 |
$2,042.72 |
| 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 |
$2,042.72
|
| 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
|
|
|
Abraxane 1 mg Charge
|
Professional
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$12.06
|
| Rate for Payer: Anthem Medicare Advantage |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.06
|
| 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 |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.71
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| 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: Independent Care Health Plan Medicare |
$12.06
|
| 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: Quartz Medicare Advantage |
$12.06
|
| Rate for Payer: The Alliance Commercial |
$33.15
|
| Rate for Payer: United Healthcare Medicaid |
$13.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.06
|
| 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: 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
|
|
|
Abrysvo RSV 0.5 mL Inj - Abrysvo Med Charge
|
Professional
|
$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 |
$177.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.40
|
| Rate for Payer: Health EOS Commercial |
$322.14
|
| 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 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: 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 vaccine preF A-preF B, recombinant 90678
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6224208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.62 |
| Max. Negotiated Rate |
$310.96 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.14
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$310.96
|
| Rate for Payer: Health EOS Commercial |
$300.82
|
| Rate for Payer: HFN Commercial |
$310.96
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: NAPHCARE Commercial |
$202.80
|
| Rate for Payer: Preferred Network Access Commercial |
$310.96
|
| Rate for Payer: Quartz Beloit One Network |
$165.62
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: WEA Trust Commercial |
$185.90
|
| Rate for Payer: WPS Commercial |
$250.36
|
|
|
Abrysvo RSV vaccine preF A-preF B, recombinant 90678
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6224208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.64 |
| Max. Negotiated Rate |
$1,352.00 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$290.68
|
| Rate for Payer: Aetna Managed Medicare |
$94.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.14
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$310.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.14
|
| Rate for Payer: Health EOS Commercial |
$300.82
|
| Rate for Payer: HFN Commercial |
$310.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.50
|
| Rate for Payer: Multiplan Commercial |
$270.40
|
| Rate for Payer: NAPHCARE Commercial |
$202.80
|
| Rate for Payer: Preferred Network Access Commercial |
$310.96
|
| Rate for Payer: Quartz Beloit One Network |
$165.62
|
| Rate for Payer: Quartz Commercial |
$219.70
|
| Rate for Payer: Quartz Medicare Advantage |
$202.80
|
| Rate for Payer: The Alliance Commercial |
$1,352.00
|
| Rate for Payer: WEA Trust Commercial |
$185.90
|
| Rate for Payer: WPS Commercial |
$250.36
|
|
|
Abrysvo RSV vaccine preF A-preF B, recombinant 90678
|
Professional
|
$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 |
$169.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.80
|
| Rate for Payer: Health EOS Commercial |
$307.58
|
| 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
|
|
|
Abscess Drainage Under XRAY 7598926
|
Professional
|
$586.00
|
|
|
Service Code
|
CPT 75989 26
|
| Hospital Charge Code |
3206188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Aetna Managed Medicare |
$53.09
|
| Rate for Payer: Anthem Medicare Advantage |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.09
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$556.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.09
|
| Rate for Payer: Health EOS Commercial |
$533.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.09
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$556.70
|
| Rate for Payer: Quartz Beloit One Network |
$257.84
|
| Rate for Payer: Quartz Commercial |
$334.02
|
| Rate for Payer: Quartz Medicare Advantage |
$53.09
|
| Rate for Payer: The Alliance Commercial |
$201.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.09
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$265.45
|
|
|
Ab Titer
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
973765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Ab Titer
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
973765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| 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 |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$189.15
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$218.25
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
ACCESSORY BONE REMOVAL
|
Facility
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2959776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
