|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$22,500.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,575.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,656.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,812.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,700.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.75
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,218.75
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,656.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,375.00
|
| Rate for Payer: The Alliance Commercial |
$22,500.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
BURR SCULPTING 4 X 16MM CYLINDER 58SC4016
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
6179880
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,756.25 |
| Max. Negotiated Rate |
$5,175.00 |
| Rate for Payer: Aetna Commercial |
$5,062.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,837.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.25
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,175.00
|
| Rate for Payer: Health EOS Commercial |
$5,006.25
|
| Rate for Payer: HFN Commercial |
$5,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,375.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,175.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.25
|
| Rate for Payer: Quartz Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,093.75
|
| Rate for Payer: WPS Commercial |
$4,166.44
|
|
|
Buspirone Level
|
Professional
|
Both
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.33 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Aetna Commercial |
$91.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.73
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$91.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.72
|
| Rate for Payer: Health EOS Commercial |
$87.54
|
| Rate for Payer: HFN Commercial |
$91.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: Preferred Network Access Commercial |
$91.39
|
| Rate for Payer: Quartz Beloit One Network |
$42.33
|
| Rate for Payer: Quartz Commercial |
$54.83
|
| Rate for Payer: The Alliance Commercial |
$48.10
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: WPS Commercial |
$71.26
|
|
|
Buspirone Level
|
Facility
|
OP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.73
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.83
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$85.62
|
| Rate for Payer: HFN Commercial |
$88.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$88.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$47.14
|
| Rate for Payer: Quartz Commercial |
$62.53
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$72.15
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$71.26
|
|
|
Buspirone Level
|
Facility
|
IP
|
$96.20
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5619725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Aetna Commercial |
$86.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.99
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna Commercial |
$88.50
|
| Rate for Payer: Health EOS Commercial |
$85.62
|
| Rate for Payer: HFN Commercial |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$76.96
|
| Rate for Payer: NAPHCARE Commercial |
$57.72
|
| Rate for Payer: Preferred Network Access Commercial |
$88.50
|
| Rate for Payer: Quartz Beloit One Network |
$47.14
|
| Rate for Payer: Quartz Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$52.91
|
| Rate for Payer: WPS Commercial |
$71.26
|
|
|
Butalbital, Urine
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Butalbital, Urine
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: HFN Commercial |
$103.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: The Alliance Commercial |
$54.50
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Butalbital, Urine
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
3313618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
|
OP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.56 |
| Max. Negotiated Rate |
$11,108.00 |
| Rate for Payer: Aetna Commercial |
$2,499.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.22
|
| Rate for Payer: Aetna Managed Medicare |
$777.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,805.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.81
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,554.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,554.01
|
| Rate for Payer: Health EOS Commercial |
$2,471.53
|
| Rate for Payer: HFN Commercial |
$2,554.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.75
|
| Rate for Payer: Multiplan Commercial |
$2,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.73
|
| Rate for Payer: Quartz Commercial |
$1,805.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,666.20
|
| Rate for Payer: The Alliance Commercial |
$11,108.00
|
| Rate for Payer: WEA Trust Commercial |
$1,527.35
|
| Rate for Payer: WPS Commercial |
$2,056.92
|
|
|
BUTTON NASAL SEPTAL 2-PART SILICONE 1524110
|
Facility
|
IP
|
$2,777.00
|
|
| Hospital Charge Code |
2965318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,360.73 |
| Max. Negotiated Rate |
$2,554.84 |
| Rate for Payer: Aetna Commercial |
$2,499.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.81
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,554.84
|
| Rate for Payer: Health EOS Commercial |
$2,471.53
|
| Rate for Payer: HFN Commercial |
$2,554.84
|
| Rate for Payer: Multiplan Commercial |
$2,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,554.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.73
|
| Rate for Payer: Quartz Commercial |
$1,666.20
|
| Rate for Payer: WEA Trust Commercial |
$1,527.35
|
| Rate for Payer: WPS Commercial |
$2,056.92
|
|
|
BUTTON NASAL SEPTAL 3CM SILICONE SINGLE UNIT 1524105
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,166.20 |
| Max. Negotiated Rate |
$2,189.60 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
BUTTON NASAL SEPTAL 3CM SILICONE SINGLE UNIT 1524105
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2965319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.40 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.80
|
| Rate for Payer: Aetna Managed Medicare |
$666.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,331.85
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.00
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,547.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.00
|
| Rate for Payer: The Alliance Commercial |
$9,520.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
BUTTON OLYMPUS BIPOLAR HF 12/30 DEG WA22760S/WA22557C
|
Facility
|
OP
|
$5,794.00
|
|
| Hospital Charge Code |
4510815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,622.32 |
| Max. Negotiated Rate |
$23,176.00 |
| Rate for Payer: Aetna Commercial |
$5,214.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,982.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,622.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,766.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,897.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,781.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,070.82
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Cigna Commercial |
$5,330.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,242.32
|
| Rate for Payer: Health EOS Commercial |
$5,156.66
|
| Rate for Payer: HFN Commercial |
$5,330.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,345.50
|
| Rate for Payer: Multiplan Commercial |
$4,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,476.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,330.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.06
|
| Rate for Payer: Quartz Commercial |
$3,766.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,476.40
|
| Rate for Payer: The Alliance Commercial |
$23,176.00
|
| Rate for Payer: WEA Trust Commercial |
$3,186.70
|
| Rate for Payer: WPS Commercial |
$4,291.62
|
|
|
BUTTON OLYMPUS BIPOLAR HF 12/30 DEG WA22760S/WA22557C
|
Facility
|
IP
|
$5,794.00
|
|
| Hospital Charge Code |
4510815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,839.06 |
| Max. Negotiated Rate |
$5,330.48 |
| Rate for Payer: Aetna Commercial |
$5,214.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,982.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,070.82
|
| Rate for Payer: Cash Price |
$1,738.20
|
| Rate for Payer: Cigna Commercial |
$5,330.48
|
| Rate for Payer: Health EOS Commercial |
$5,156.66
|
| Rate for Payer: HFN Commercial |
$5,330.48
|
| Rate for Payer: Multiplan Commercial |
$4,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,476.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,330.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.06
|
| Rate for Payer: Quartz Commercial |
$3,476.40
|
| Rate for Payer: WEA Trust Commercial |
$3,186.70
|
| Rate for Payer: WPS Commercial |
$4,291.62
|
|
|
BX BREAST PERCUT W/IMAGE 19102
|
Professional
|
Both
|
$1,076.00
|
|
| Hospital Charge Code |
3013677
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$473.44 |
| Max. Negotiated Rate |
$1,022.20 |
| Rate for Payer: Aetna Commercial |
$1,022.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$925.36
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$1,022.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$538.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.60
|
| Rate for Payer: Health EOS Commercial |
$979.16
|
| Rate for Payer: HFN Commercial |
$1,022.20
|
| Rate for Payer: Multiplan Commercial |
$860.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.20
|
| Rate for Payer: Quartz Beloit One Network |
$473.44
|
| Rate for Payer: Quartz Commercial |
$613.32
|
| Rate for Payer: The Alliance Commercial |
$538.00
|
| Rate for Payer: WEA Trust Commercial |
$591.80
|
| Rate for Payer: WPS Commercial |
$796.99
|
|
|
BX BREAST PERCUT W/O IMAGE 19100
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
3013675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.70
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.00
|
| Rate for Payer: Health EOS Commercial |
$541.45
|
| Rate for Payer: HFN Commercial |
$565.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.06
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.25
|
| Rate for Payer: Quartz Beloit One Network |
$261.80
|
| Rate for Payer: Quartz Commercial |
$339.15
|
| Rate for Payer: The Alliance Commercial |
$297.50
|
| Rate for Payer: United Healthcare Medicaid |
$57.15
|
| Rate for Payer: WEA Trust Commercial |
$327.25
|
| Rate for Payer: WPS Commercial |
$440.72
|
|
|
BX Breast w/Device addl Lesion Ultrasound 19084
|
Professional
|
Both
|
$2,494.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
4586627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$2,369.30 |
| Rate for Payer: Aetna Commercial |
$2,369.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,144.84
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cash Price |
$748.20
|
| Rate for Payer: Cigna Commercial |
$2,369.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,496.40
|
| Rate for Payer: Health EOS Commercial |
$2,269.54
|
| Rate for Payer: HFN Commercial |
$2,369.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$1,995.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.36
|
| Rate for Payer: Quartz Commercial |
$1,421.58
|
| Rate for Payer: The Alliance Commercial |
$1,247.00
|
| Rate for Payer: United Healthcare Medicaid |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$1,371.70
|
| Rate for Payer: WPS Commercial |
$1,847.31
|
|
|
BX Done W/Colposcopy Add-On 58110
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
3867360
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$134.39 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.39
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.26
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
C02/membane diffuse capacity 9472926
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 94729 26
|
| Hospital Charge Code |
3015459
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.80
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: HFN Commercial |
$107.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$56.50
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
C1 Esterase Inhibitor Protein
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
1038810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicaid |
$12.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.24
|
| Rate for Payer: Dean Health Medicaid |
$12.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.40
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$229.50
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WMAP Medicaid |
$12.40
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
C1 Esterase Inhibitor Protein
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
1038810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.36 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.60
|
| Rate for Payer: Health EOS Commercial |
$278.46
|
| Rate for Payer: HFN Commercial |
$290.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.36
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$290.70
|
| Rate for Payer: Quartz Beloit One Network |
$134.64
|
| Rate for Payer: Quartz Commercial |
$174.42
|
| Rate for Payer: The Alliance Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
C1 Esterase Inhibitor Protein
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
1038810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
C1 Inhibitor Functional
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
1038811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicaid |
$12.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Dean Health Medicaid |
$12.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WMAP Medicaid |
$12.40
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
C1 Inhibitor Functional
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
1038811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.00
|
| Rate for Payer: Health EOS Commercial |
$63.70
|
| Rate for Payer: HFN Commercial |
$66.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.36
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Preferred Network Access Commercial |
$66.50
|
| Rate for Payer: Quartz Beloit One Network |
$30.80
|
| Rate for Payer: Quartz Commercial |
$39.90
|
| Rate for Payer: The Alliance Commercial |
$35.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
C1 Inhibitor Functional
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
1038811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
