|
C diff B
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.13
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$432.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$498.75
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
C diff B
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Aetna Commercial |
$631.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$631.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.00
|
| Rate for Payer: Health EOS Commercial |
$605.15
|
| Rate for Payer: HFN Commercial |
$631.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Preferred Network Access Commercial |
$631.75
|
| Rate for Payer: Quartz Beloit One Network |
$292.60
|
| Rate for Payer: Quartz Commercial |
$379.05
|
| Rate for Payer: The Alliance Commercial |
$332.50
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
C diff B
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$399.00
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.84 |
| Max. Negotiated Rate |
$131.56 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.60
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: HFN Commercial |
$129.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.56
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.87
|
| Rate for Payer: Anthem Medicaid |
$38.51
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.11
|
| Rate for Payer: Dean Health Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicaid |
$40.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.51
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicaid |
$38.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WMAP Medicaid |
$38.51
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
C diff Toxin A/B, EIA
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
C diff Toxin A/B, EIA
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
C diff Toxin A/B, EIA
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
C. diff Toxin/GDH
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
C. diff Toxin/GDH
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Aetna Commercial |
$95.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$95.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.60
|
| Rate for Payer: Health EOS Commercial |
$91.91
|
| Rate for Payer: HFN Commercial |
$95.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Preferred Network Access Commercial |
$95.95
|
| Rate for Payer: Quartz Beloit One Network |
$44.44
|
| Rate for Payer: Quartz Commercial |
$57.57
|
| Rate for Payer: The Alliance Commercial |
$50.50
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
C. diff Toxin/GDH
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Aetna Managed Medicare |
$392.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.44
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$910.00
|
| Rate for Payer: Quartz Medicare Advantage |
$840.00
|
| Rate for Payer: The Alliance Commercial |
$5,600.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
OP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,202.88 |
| Max. Negotiated Rate |
$17,184.00 |
| Rate for Payer: Aetna Commercial |
$3,866.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,694.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,202.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,792.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,148.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,062.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,276.88
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$3,952.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,404.04
|
| Rate for Payer: Health EOS Commercial |
$3,823.44
|
| Rate for Payer: HFN Commercial |
$3,952.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,222.00
|
| Rate for Payer: Multiplan Commercial |
$3,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,577.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.04
|
| Rate for Payer: Quartz Commercial |
$2,792.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,577.60
|
| Rate for Payer: The Alliance Commercial |
$17,184.00
|
| Rate for Payer: WEA Trust Commercial |
$2,362.80
|
| Rate for Payer: WPS Commercial |
$3,182.05
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
IP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,105.04 |
| Max. Negotiated Rate |
$3,952.32 |
| Rate for Payer: Aetna Commercial |
$3,866.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,694.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,276.88
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$3,952.32
|
| Rate for Payer: Health EOS Commercial |
$3,823.44
|
| Rate for Payer: HFN Commercial |
$3,952.32
|
| Rate for Payer: Multiplan Commercial |
$3,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,577.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,952.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.04
|
| Rate for Payer: Quartz Commercial |
$2,577.60
|
| Rate for Payer: WEA Trust Commercial |
$2,362.80
|
| Rate for Payer: WPS Commercial |
$3,182.05
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
OP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.72 |
| Max. Negotiated Rate |
$9,296.00 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Aetna Managed Medicare |
$650.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.51
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,743.00
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,510.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.40
|
| Rate for Payer: The Alliance Commercial |
$9,296.00
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
IP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,138.76 |
| Max. Negotiated Rate |
$2,138.08 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,394.40
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
OP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.04 |
| Max. Negotiated Rate |
$10,472.00 |
| Rate for Payer: Aetna Commercial |
$2,356.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,251.48
|
| Rate for Payer: Aetna Managed Medicare |
$733.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,701.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,309.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,256.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,387.54
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,408.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,465.03
|
| Rate for Payer: Health EOS Commercial |
$2,330.02
|
| Rate for Payer: HFN Commercial |
$2,408.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,963.50
|
| Rate for Payer: Multiplan Commercial |
$2,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,570.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,408.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.82
|
| Rate for Payer: Quartz Commercial |
$1,701.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,570.80
|
| Rate for Payer: The Alliance Commercial |
$10,472.00
|
| Rate for Payer: WEA Trust Commercial |
$1,439.90
|
| Rate for Payer: WPS Commercial |
$1,939.15
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
IP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,282.82 |
| Max. Negotiated Rate |
$2,408.56 |
| Rate for Payer: Aetna Commercial |
$2,356.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,251.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,387.54
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,408.56
|
| Rate for Payer: Health EOS Commercial |
$2,330.02
|
| Rate for Payer: HFN Commercial |
$2,408.56
|
| Rate for Payer: Multiplan Commercial |
$2,094.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,570.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,408.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,282.82
|
| Rate for Payer: Quartz Commercial |
$1,570.80
|
| Rate for Payer: WEA Trust Commercial |
$1,439.90
|
| Rate for Payer: WPS Commercial |
$1,939.15
|
|
|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.56 |
| Max. Negotiated Rate |
$9,608.00 |
| Rate for Payer: Aetna Commercial |
$2,161.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,065.72
|
| Rate for Payer: Aetna Managed Medicare |
$672.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,561.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.06
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,209.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,344.16
|
| Rate for Payer: Health EOS Commercial |
$2,137.78
|
| Rate for Payer: HFN Commercial |
$2,209.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,801.50
|
| Rate for Payer: Multiplan Commercial |
$1,921.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,441.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,209.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.98
|
| Rate for Payer: Quartz Commercial |
$1,561.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,441.20
|
| Rate for Payer: The Alliance Commercial |
$9,608.00
|
| Rate for Payer: WEA Trust Commercial |
$1,321.10
|
| Rate for Payer: WPS Commercial |
$1,779.16
|
|
