|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
IP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.73 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$599.66
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
CDS PODIATRY BOX DYNJ900879
|
Facility
|
OP
|
$961.00
|
|
| Hospital Charge Code |
4124775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.84 |
| Max. Negotiated Rate |
$919.48 |
| Rate for Payer: Aetna Commercial |
$899.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.52
|
| Rate for Payer: Aetna Managed Medicare |
$279.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$499.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$479.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.70
|
| Rate for Payer: Cash Price |
$288.30
|
| Rate for Payer: Cigna Commercial |
$919.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.30
|
| Rate for Payer: Health EOS Commercial |
$889.50
|
| Rate for Payer: HFN Commercial |
$919.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$749.58
|
| Rate for Payer: Multiplan Commercial |
$799.55
|
| Rate for Payer: NAPHCARE Commercial |
$599.66
|
| Rate for Payer: Preferred Network Access Commercial |
$919.48
|
| Rate for Payer: Quartz Beloit One Network |
$489.73
|
| Rate for Payer: Quartz Commercial |
$649.64
|
| Rate for Payer: Quartz Medicare Advantage |
$599.66
|
| Rate for Payer: The Alliance Commercial |
$499.72
|
| Rate for Payer: WEA Trust Commercial |
$549.69
|
| Rate for Payer: WPS Commercial |
$740.26
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
OP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Aetna Managed Medicare |
$744.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,728.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,329.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,276.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,488.17
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,994.46
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,728.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,595.57
|
| Rate for Payer: The Alliance Commercial |
$1,329.64
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
CDS SHOULDER BOX DYNJ900889
|
Facility
|
IP
|
$2,557.00
|
|
| Hospital Charge Code |
4124773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.05 |
| Max. Negotiated Rate |
$2,446.54 |
| Rate for Payer: Aetna Commercial |
$2,393.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,286.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,409.42
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cigna Commercial |
$2,446.54
|
| Rate for Payer: Health EOS Commercial |
$2,366.76
|
| Rate for Payer: HFN Commercial |
$2,446.54
|
| Rate for Payer: Multiplan Commercial |
$2,127.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,446.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.05
|
| Rate for Payer: Quartz Commercial |
$1,595.57
|
| Rate for Payer: WEA Trust Commercial |
$1,462.60
|
| Rate for Payer: WPS Commercial |
$1,969.66
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
IP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.62 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,470.14
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CDS T & A BOX DYNJ900890
|
Facility
|
OP
|
$2,356.00
|
|
| Hospital Charge Code |
4115513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Aetna Managed Medicare |
$686.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,592.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.19
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,837.68
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,592.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.14
|
| Rate for Payer: The Alliance Commercial |
$1,225.12
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
OP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.58 |
| Max. Negotiated Rate |
$4,112.33 |
| Rate for Payer: Aetna Commercial |
$4,022.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,844.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,905.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,234.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,145.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.06
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$4,112.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,501.44
|
| Rate for Payer: Health EOS Commercial |
$3,978.23
|
| Rate for Payer: HFN Commercial |
$4,112.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,352.44
|
| Rate for Payer: Multiplan Commercial |
$3,575.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,681.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,112.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.26
|
| Rate for Payer: Quartz Commercial |
$2,905.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,681.95
|
| Rate for Payer: The Alliance Commercial |
$2,234.96
|
| Rate for Payer: WEA Trust Commercial |
$2,458.46
|
| Rate for Payer: WPS Commercial |
$3,310.75
|
|
|
CDS TOTAL HIP BOX DYNJ900882
|
Facility
|
IP
|
$4,298.00
|
|
| Hospital Charge Code |
4124767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,190.26 |
| Max. Negotiated Rate |
$4,112.33 |
| Rate for Payer: Aetna Commercial |
$4,022.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,844.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,369.06
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cigna Commercial |
$4,112.33
|
| Rate for Payer: Health EOS Commercial |
$3,978.23
|
| Rate for Payer: HFN Commercial |
$4,112.33
|
| Rate for Payer: Multiplan Commercial |
$3,575.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,112.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,190.26
|
| Rate for Payer: Quartz Commercial |
$2,681.95
|
| Rate for Payer: WEA Trust Commercial |
$2,458.46
|
| Rate for Payer: WPS Commercial |
$3,310.75
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
OP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,675.86 |
| Max. Negotiated Rate |
$5,506.38 |
| Rate for Payer: Aetna Commercial |
$5,386.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,147.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,675.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,890.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,992.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,872.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,172.16
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,506.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,349.41
|
| Rate for Payer: Health EOS Commercial |
$5,326.83
|
| Rate for Payer: HFN Commercial |
$5,506.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,488.90
|
| Rate for Payer: Multiplan Commercial |
$4,788.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,591.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,506.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.75
|
| Rate for Payer: Quartz Commercial |
$3,890.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,591.12
|
| Rate for Payer: The Alliance Commercial |
$2,992.60
|
| Rate for Payer: WEA Trust Commercial |
$3,291.86
|
| Rate for Payer: WPS Commercial |
$4,433.08
|
|
|
CDS TOTAL KNEE BOX DYNJ900881
|
Facility
|
IP
|
$5,755.00
|
|
| Hospital Charge Code |
4124766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,932.75 |
| Max. Negotiated Rate |
$5,506.38 |
| Rate for Payer: Aetna Commercial |
$5,386.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,147.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,172.16
|
| Rate for Payer: Cash Price |
$1,726.50
|
| Rate for Payer: Cigna Commercial |
$5,506.38
|
| Rate for Payer: Health EOS Commercial |
$5,326.83
|
| Rate for Payer: HFN Commercial |
$5,506.38
|
| Rate for Payer: Multiplan Commercial |
$4,788.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,506.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,932.75
|
| Rate for Payer: Quartz Commercial |
$3,591.12
|
| Rate for Payer: WEA Trust Commercial |
$3,291.86
|
| Rate for Payer: WPS Commercial |
$4,433.08
|
|
|
CDS UPPER EXTREMITY BOX DYNJ900880
|
Facility
|
IP
|
$1,904.00
|
|
| Hospital Charge Code |
4124776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CDS UPPER EXTREMITY BOX DYNJ900880
|
Facility
|
OP
|
$1,904.00
|
|
| Hospital Charge Code |
4124776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CEA, Peritoneal Fluid
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
5791656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.72
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.72
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$29.58
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$19.72
|
| Rate for Payer: The Alliance Commercial |
$78.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.72
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$19.72
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CEA, Peritoneal Fluid
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
5791656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$19.72
|
| Rate for Payer: Anthem Medicare Advantage |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.72
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.72
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$29.58
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.72
|
| Rate for Payer: The Alliance Commercial |
$77.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$86.76
|
|
|
CEA, Peritoneal Fluid
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
5791656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Cefazolin 1gm vial [Med]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2974907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$10.61
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Cefazolin 1gm vial [Med]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2974907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.61
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$11.49
|
| Rate for Payer: Quartz Medicare Advantage |
$10.61
|
| Rate for Payer: The Alliance Commercial |
$3.45
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$2.12
|
|
|
Cefazolin 2gm Vial (Med)
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
6226125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Cefazolin 2gm Vial (Med)
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
6226125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$3.45
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$2.12
|
|
|
Cefazolin (Ancef)
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4075399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$19.34
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$19.34
|
| Rate for Payer: The Alliance Commercial |
$3.45
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$2.12
|
|
|
Cefazolin (Ancef)
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
4075399
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Cefazolin JW Waste Charge per 500 mg
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0690 JW
|
| Hospital Charge Code |
5266692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.85
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicaid |
$0.86
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$2.12
|
|
|
Cefazolin JW Waste Charge per 500 mg
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690 JW
|
| Hospital Charge Code |
5266692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$2.12
|
|
|
Cefazolin JW Waste Charge per 500 mg
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0690 JW
|
| Hospital Charge Code |
5266692
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Cefoxitin 1gm vial [Med]
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
2974918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
