|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$10,258.92
|
|
|
Service Code
|
APR-DRG 5433
|
| Min. Negotiated Rate |
$9,112.62 |
| Max. Negotiated Rate |
$10,258.92 |
| Rate for Payer: Anthem Medicaid |
$9,823.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,823.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,823.48
|
| Rate for Payer: Dean Health Medicaid |
$9,823.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,112.62
|
| Rate for Payer: Managed Health Services Medicaid |
$10,258.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,823.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,823.48
|
| Rate for Payer: United Healthcare Medicaid |
$9,823.48
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$19,816.38
|
|
|
Service Code
|
APR-DRG 5434
|
| Min. Negotiated Rate |
$17,602.15 |
| Max. Negotiated Rate |
$19,816.38 |
| Rate for Payer: Anthem Medicaid |
$18,975.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,975.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,975.28
|
| Rate for Payer: Dean Health Medicaid |
$18,975.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,602.15
|
| Rate for Payer: Managed Health Services Medicaid |
$19,816.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,975.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,975.28
|
| Rate for Payer: United Healthcare Medicaid |
$18,975.28
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$22,417.20
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$8,185.66 |
| Max. Negotiated Rate |
$22,417.20 |
| Rate for Payer: Aetna Managed Medicare |
$8,185.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,878.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,769.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,932.02
|
| Rate for Payer: Anthem Medicare Advantage |
$8,185.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,185.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,185.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,185.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,686.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,185.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,197.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,185.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,185.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,185.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,185.66
|
| Rate for Payer: NAPHCARE Commercial |
$12,278.49
|
| Rate for Payer: Quartz Medicare Advantage |
$8,185.66
|
| Rate for Payer: The Alliance Commercial |
$22,417.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,185.66
|
| Rate for Payer: United Healthcare PPO |
$12,610.06
|
| Rate for Payer: Wellcare Medicare |
$8,185.66
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$27,683.76
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$6,949.61 |
| Max. Negotiated Rate |
$27,683.76 |
| Rate for Payer: Aetna Managed Medicare |
$6,949.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,559.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,926.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,330.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6,949.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,949.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,949.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,949.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,577.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,949.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,060.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,949.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,949.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,949.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,949.61
|
| Rate for Payer: NAPHCARE Commercial |
$10,424.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,949.61
|
| Rate for Payer: The Alliance Commercial |
$27,683.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,949.61
|
| Rate for Payer: United Healthcare PPO |
$15,617.73
|
| Rate for Payer: Wellcare Medicare |
$6,949.61
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 5643
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$15,607.59
|
|
|
Service Code
|
APR-DRG 5644
|
| Min. Negotiated Rate |
$13,863.64 |
| Max. Negotiated Rate |
$15,607.59 |
| Rate for Payer: Anthem Medicaid |
$14,945.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,945.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,945.13
|
| Rate for Payer: Dean Health Medicaid |
$14,945.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,863.64
|
| Rate for Payer: Managed Health Services Medicaid |
$15,607.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,945.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,945.13
|
| Rate for Payer: United Healthcare Medicaid |
$14,945.13
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$3,068.91
|
|
|
Service Code
|
APR-DRG 5641
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$3,068.91 |
| Rate for Payer: Anthem Medicaid |
$2,938.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,938.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,938.65
|
| Rate for Payer: Dean Health Medicaid |
$2,938.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$3,068.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,938.65
|
| Rate for Payer: United Healthcare Medicaid |
$2,938.65
|
|
|
ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$4,296.47
|
|
|
Service Code
|
APR-DRG 5642
|
| Min. Negotiated Rate |
$3,816.39 |
| Max. Negotiated Rate |
$4,296.47 |
| Rate for Payer: Anthem Medicaid |
$4,114.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,114.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,114.11
|
| Rate for Payer: Dean Health Medicaid |
$4,114.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,816.39
|
| Rate for Payer: Managed Health Services Medicaid |
$4,296.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,114.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,114.11
|
| Rate for Payer: United Healthcare Medicaid |
$4,114.11
|
|
|
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 |
$555.52 |
| Max. Negotiated Rate |
$2,499.82 |
| Rate for Payer: Aetna Commercial |
$1,260.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Aetna Managed Medicare |
$555.52
|
| Rate for Payer: Anthem Medicare Advantage |
$555.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$555.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$555.52
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,260.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$940.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.52
|
| Rate for Payer: Health EOS Commercial |
$1,207.61
|
| Rate for Payer: HFN Commercial |
$1,260.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,330.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,330.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$555.52
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: NAPHCARE Commercial |
$833.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.69
|
| Rate for Payer: Quartz Beloit One Network |
$583.90
|
| Rate for Payer: Quartz Commercial |
$756.41
|
| Rate for Payer: Quartz Medicare Advantage |
$555.52
|
| Rate for Payer: The Alliance Commercial |
$2,360.94
|
| Rate for Payer: United Healthcare Medicaid |
$940.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$555.52
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$2,499.82
|
|
|
Abraxane 1 mg Charge
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Abraxane 1 mg Charge
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$8.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.51
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.51
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.76
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8.51
|
| Rate for Payer: The Alliance Commercial |
$34.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.51
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$8.51
|
| Rate for Payer: WPS Commercial |
$35.66
|
|
|
Abraxane 1 mg Charge
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
2958860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$8.51
|
| Rate for Payer: Anthem Medicare Advantage |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.51
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.26
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.76
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8.51
|
| Rate for Payer: The Alliance Commercial |
$23.39
|
| Rate for Payer: United Healthcare Medicaid |
$8.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.51
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$35.66
|
|
|
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 |
$103.08 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$103.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.12
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$220.90
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$220.90
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
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 |
$161.99 |
| Max. Negotiated Rate |
$349.75 |
| Rate for Payer: Aetna Commercial |
$349.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$349.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.90
|
| Rate for Payer: Health EOS Commercial |
$335.03
|
| Rate for Payer: HFN Commercial |
$349.75
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$349.75
|
| Rate for Payer: Quartz Beloit One Network |
$161.99
|
| Rate for Payer: Quartz Commercial |
$209.85
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: United Healthcare Medicaid |
$319.07
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
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 |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
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 |
$154.67 |
| Max. Negotiated Rate |
$333.94 |
| Rate for Payer: Aetna Commercial |
$333.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$302.31
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$333.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.91
|
| Rate for Payer: Health EOS Commercial |
$319.88
|
| Rate for Payer: HFN Commercial |
$333.94
|
| Rate for Payer: Multiplan Commercial |
$281.22
|
| Rate for Payer: Preferred Network Access Commercial |
$333.94
|
| Rate for Payer: Quartz Beloit One Network |
$154.67
|
| Rate for Payer: Quartz Commercial |
$200.37
|
| Rate for Payer: The Alliance Commercial |
$175.76
|
| Rate for Payer: United Healthcare Medicaid |
$319.07
|
| Rate for Payer: WEA Trust Commercial |
$193.34
|
| Rate for Payer: WPS Commercial |
$260.36
|
|
|
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 |
$172.24 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: Aetna Commercial |
$316.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$302.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.31
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$323.40
|
| Rate for Payer: Health EOS Commercial |
$312.85
|
| Rate for Payer: HFN Commercial |
$323.40
|
| Rate for Payer: Multiplan Commercial |
$281.22
|
| Rate for Payer: Preferred Network Access Commercial |
$323.40
|
| Rate for Payer: Quartz Beloit One Network |
$172.24
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: WEA Trust Commercial |
$193.34
|
| Rate for Payer: WPS Commercial |
$260.36
|
|
|
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 |
$98.43 |
| Max. Negotiated Rate |
$323.40 |
| Rate for Payer: Aetna Commercial |
$316.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$302.31
|
| Rate for Payer: Aetna Managed Medicare |
$98.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$228.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.31
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cigna Commercial |
$323.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.72
|
| Rate for Payer: Health EOS Commercial |
$312.85
|
| Rate for Payer: HFN Commercial |
$323.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$263.64
|
| Rate for Payer: Multiplan Commercial |
$281.22
|
| Rate for Payer: NAPHCARE Commercial |
$210.91
|
| Rate for Payer: Preferred Network Access Commercial |
$323.40
|
| Rate for Payer: Quartz Beloit One Network |
$172.24
|
| Rate for Payer: Quartz Commercial |
$228.49
|
| Rate for Payer: Quartz Medicare Advantage |
$210.91
|
| Rate for Payer: The Alliance Commercial |
$175.76
|
| Rate for Payer: WEA Trust Commercial |
$193.34
|
| Rate for Payer: WPS Commercial |
$260.36
|
|
|
Abscess Drainage Under XRAY 7598926
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 75989 26
|
| Hospital Charge Code |
3206188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.13 |
| Max. Negotiated Rate |
$578.97 |
| Rate for Payer: Aetna Commercial |
$578.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Aetna Managed Medicare |
$54.13
|
| Rate for Payer: Anthem Medicare Advantage |
$54.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.13
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$578.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$554.59
|
| Rate for Payer: HFN Commercial |
$578.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.13
|
| Rate for Payer: Multiplan Commercial |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$81.20
|
| Rate for Payer: Preferred Network Access Commercial |
$578.97
|
| Rate for Payer: Quartz Beloit One Network |
$268.15
|
| Rate for Payer: Quartz Commercial |
$347.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.13
|
| Rate for Payer: The Alliance Commercial |
$205.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.13
|
| Rate for Payer: WEA Trust Commercial |
$335.19
|
| Rate for Payer: WPS Commercial |
$270.66
|
|
|
Ab Titer
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
973765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Ab Titer
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
973765
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$658.40 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$226.98
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
ACCESSORY BONE REMOVAL
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2959776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
ACCESSORY BONE REMOVAL
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2959776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
ACCESSORY KIT AMS 800 720066-01
|
Facility
|
IP
|
$7,154.00
|
|
| Hospital Charge Code |
5385017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,645.68 |
| Max. Negotiated Rate |
$6,844.95 |
| Rate for Payer: Aetna Commercial |
$6,696.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,398.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,943.28
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: Cigna Commercial |
$6,844.95
|
| Rate for Payer: Health EOS Commercial |
$6,621.74
|
| Rate for Payer: HFN Commercial |
$6,844.95
|
| Rate for Payer: Multiplan Commercial |
$5,952.13
|
| Rate for Payer: Preferred Network Access Commercial |
$6,844.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,645.68
|
| Rate for Payer: Quartz Commercial |
$4,464.10
|
| Rate for Payer: WEA Trust Commercial |
$4,092.09
|
| Rate for Payer: WPS Commercial |
$5,510.73
|
|
