|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$19,986.00
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$7,189.25 |
| Max. Negotiated Rate |
$19,986.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,189.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,189.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,189.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,189.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,189.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,424.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,189.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,189.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,189.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,189.25
|
| Rate for Payer: NAPHCARE Commercial |
$10,783.88
|
| Rate for Payer: Quartz Medicare Advantage |
$7,189.25
|
| Rate for Payer: The Alliance Commercial |
$19,986.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,189.25
|
| Rate for Payer: United Healthcare PPO |
$11,229.39
|
| Rate for Payer: Wellcare Medicare |
$7,189.25
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$52,732.00
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$18,968.34 |
| Max. Negotiated Rate |
$52,732.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,968.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,330.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,679.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,097.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18,968.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,968.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,968.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,968.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,411.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,968.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,442.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,968.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,968.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,968.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,968.34
|
| Rate for Payer: NAPHCARE Commercial |
$28,452.51
|
| Rate for Payer: Quartz Medicare Advantage |
$18,968.34
|
| Rate for Payer: The Alliance Commercial |
$52,732.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,968.34
|
| Rate for Payer: United Healthcare PPO |
$29,927.82
|
| Rate for Payer: Wellcare Medicare |
$18,968.34
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$13,313.00
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$4,788.85 |
| Max. Negotiated Rate |
$13,313.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,788.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,280.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,879.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,486.22
|
| Rate for Payer: Anthem Medicare Advantage |
$4,788.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,788.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,788.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,788.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,310.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,788.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,529.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,788.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,788.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,788.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,788.85
|
| Rate for Payer: NAPHCARE Commercial |
$7,183.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4,788.85
|
| Rate for Payer: The Alliance Commercial |
$13,313.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,788.85
|
| Rate for Payer: United Healthcare PPO |
$7,418.95
|
| Rate for Payer: Wellcare Medicare |
$4,788.85
|
|
|
Acute Peritoneal Dialysis
|
Facility
|
OP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$665.84 |
| Max. Negotiated Rate |
$9,512.00 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Aetna Managed Medicare |
$665.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,545.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,330.73
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,783.50
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,545.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,426.80
|
| Rate for Payer: The Alliance Commercial |
$9,512.00
|
| Rate for Payer: United Healthcare PPO |
$1,783.50
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
Acute Peritoneal Dialysis
|
Facility
|
IP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$1,165.22 |
| Max. Negotiated Rate |
$2,187.76 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,426.80
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
Acylcarnitines Quantitative
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Acylcarnitines Quantitative
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$67.48
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Acylcarnitines Quantitative
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Adalimumab ADA
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| 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 |
$147.34
|
| 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 |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| 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 |
$155.57
|
| 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 |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| 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 |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| 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 |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab ADA
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$264.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.80
|
| Rate for Payer: Health EOS Commercial |
$252.98
|
| Rate for Payer: HFN Commercial |
$264.10
|
| 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 |
$222.40
|
| Rate for Payer: Preferred Network Access Commercial |
$264.10
|
| Rate for Payer: Quartz Beloit One Network |
$122.32
|
| Rate for Payer: Quartz Commercial |
$158.46
|
| Rate for Payer: The Alliance Commercial |
$139.00
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab ADA
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| 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 |
$147.34
|
| 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 |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| 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 |
$155.57
|
| 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 |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| 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 |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$180.70
|
| 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 |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$264.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$264.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.80
|
| Rate for Payer: Health EOS Commercial |
$252.98
|
| Rate for Payer: HFN Commercial |
$264.10
|
| 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 |
$222.40
|
| Rate for Payer: Preferred Network Access Commercial |
$264.10
|
| Rate for Payer: Quartz Beloit One Network |
$122.32
|
| Rate for Payer: Quartz Commercial |
$158.46
|
| Rate for Payer: The Alliance Commercial |
$139.00
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
Adalimumab Drug Levels
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$255.76 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.34
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$255.76
|
| Rate for Payer: Health EOS Commercial |
$247.42
|
| Rate for Payer: HFN Commercial |
$255.76
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: NAPHCARE Commercial |
$166.80
|
| Rate for Payer: Preferred Network Access Commercial |
$255.76
|
| Rate for Payer: Quartz Beloit One Network |
$136.22
|
| Rate for Payer: Quartz Commercial |
$166.80
|
| Rate for Payer: WEA Trust Commercial |
$152.90
|
| Rate for Payer: WPS Commercial |
$205.91
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.00
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.94
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: The Alliance Commercial |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$30.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.23
|
| Rate for Payer: Anthem Medicaid |
$31.89
|
| Rate for Payer: Anthem Medicare Advantage |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.86
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.24
|
| Rate for Payer: Dean Health Medicaid |
$31.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.86
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.86
|
| Rate for Payer: Managed Health Services Medicaid |
$33.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.86
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$46.29
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31.89
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$30.86
|
| Rate for Payer: The Alliance Commercial |
$123.44
|
| Rate for Payer: United Healthcare Medicaid |
$31.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.86
|
| Rate for Payer: United Healthcare PPO |
$292.50
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: Wellcare Medicare |
$30.86
|
| Rate for Payer: WMAP Medicaid |
$31.89
|
| Rate for Payer: WPS Commercial |
$288.87
|
|
|
.ADAMTS13 Inhibitor
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.00
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.43
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
.ADAMTS13 Inhibitor
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
.ADAMTS13 Inhibitor
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$12.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.36
|
| Rate for Payer: Anthem Medicaid |
$13.30
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.87
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Dean Health Medicaid |
$13.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Managed Health Services Medicaid |
$13.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.30
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.30
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicaid |
$13.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare PPO |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: WMAP Medicaid |
$13.30
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
ADAPTER 24F Y-PORT FEEDING TUBE M00580651
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
4266108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
ADAPTER 24F Y-PORT FEEDING TUBE M00580651
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
4266108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.75
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$118.20
|
| Rate for Payer: The Alliance Commercial |
$788.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
ADAPTER ADLOCKING TITANIUM PD CATHETER(2 PC) 5C4129
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
4519869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,543.01 |
| Max. Negotiated Rate |
$2,897.08 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$1,889.40
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
ADAPTER ADLOCKING TITANIUM PD CATHETER(2 PC) 5C4129
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
4519869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.72 |
| Max. Negotiated Rate |
$12,596.00 |
| Rate for Payer: Aetna Commercial |
$2,834.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,708.14
|
| Rate for Payer: Aetna Managed Medicare |
$881.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,046.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,574.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,511.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,668.97
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$2,897.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,762.18
|
| Rate for Payer: Health EOS Commercial |
$2,802.61
|
| Rate for Payer: HFN Commercial |
$2,897.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,361.75
|
| Rate for Payer: Multiplan Commercial |
$2,519.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,543.01
|
| Rate for Payer: Quartz Commercial |
$2,046.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,889.40
|
| Rate for Payer: The Alliance Commercial |
$12,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,731.95
|
| Rate for Payer: WPS Commercial |
$2,332.46
|
|
|
ADAPTER ANES CIRCUIT OXYGEN
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2974458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
