|
C diff B
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$657.02 |
| Rate for Payer: Aetna Commercial |
$657.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$657.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$345.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$629.36
|
| Rate for Payer: HFN Commercial |
$657.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$657.02
|
| Rate for Payer: Quartz Beloit One Network |
$304.30
|
| Rate for Payer: Quartz Commercial |
$394.21
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
C diff B
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$636.27
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
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 |
$38.76 |
| Max. Negotiated Rate |
$155.04 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$38.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.34
|
| Rate for Payer: Anthem Medicare Advantage |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.76
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.76
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$58.14
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$38.76
|
| Rate for Payer: The Alliance Commercial |
$155.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.76
|
| Rate for Payer: United Healthcare PPO |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: Wellcare Medicare |
$38.76
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
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 |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
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 |
$38.76 |
| Max. Negotiated Rate |
$170.55 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.76
|
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$38.76
|
| Rate for Payer: Anthem Medicare Advantage |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.76
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.76
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$58.14
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$38.76
|
| Rate for Payer: The Alliance Commercial |
$153.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.76
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$170.55
|
|
|
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 |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
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 |
$12.46 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
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 |
$12.46 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
C. diff Toxin/GDH
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: Aetna Commercial |
$99.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.33
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$99.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$95.59
|
| Rate for Payer: HFN Commercial |
$99.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$84.03
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$99.79
|
| Rate for Payer: Quartz Beloit One Network |
$46.22
|
| Rate for Payer: Quartz Commercial |
$59.87
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$57.77
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
C. diff Toxin/GDH
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$96.64 |
| Rate for Payer: Aetna Commercial |
$94.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.33
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$96.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$93.49
|
| Rate for Payer: HFN Commercial |
$96.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$84.03
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$96.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.47
|
| Rate for Payer: Quartz Commercial |
$68.28
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$78.78
|
| Rate for Payer: WEA Trust Commercial |
$57.77
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$77.80
|
|
|
C. diff Toxin/GDH
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.47 |
| Max. Negotiated Rate |
$96.64 |
| Rate for Payer: Aetna Commercial |
$94.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.67
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$96.64
|
| Rate for Payer: Health EOS Commercial |
$93.49
|
| Rate for Payer: HFN Commercial |
$96.64
|
| Rate for Payer: Multiplan Commercial |
$84.03
|
| Rate for Payer: Preferred Network Access Commercial |
$96.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.47
|
| Rate for Payer: Quartz Commercial |
$63.02
|
| Rate for Payer: WEA Trust Commercial |
$57.77
|
| Rate for Payer: WPS Commercial |
$77.80
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
|
OP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$946.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.80
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$873.60
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
OP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,251.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,904.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,233.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,144.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,500.27
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,350.88
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: NAPHCARE Commercial |
$2,680.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,904.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,680.70
|
| Rate for Payer: The Alliance Commercial |
$2,233.92
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
CDS GENERAL LAPAROSCOPY BOX DYNJ900885
|
Facility
|
IP
|
$4,296.00
|
|
| Hospital Charge Code |
4124770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,189.24 |
| Max. Negotiated Rate |
$4,110.41 |
| Rate for Payer: Aetna Commercial |
$4,021.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,842.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,367.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cigna Commercial |
$4,110.41
|
| Rate for Payer: Health EOS Commercial |
$3,976.38
|
| Rate for Payer: HFN Commercial |
$4,110.41
|
| Rate for Payer: Multiplan Commercial |
$3,574.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,110.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,189.24
|
| Rate for Payer: Quartz Commercial |
$2,680.70
|
| Rate for Payer: WEA Trust Commercial |
$2,457.31
|
| Rate for Payer: WPS Commercial |
$3,309.21
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
IP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.31 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,450.18
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
CDS GYN LAPAROSCOPY BOX DYNJ900887
|
Facility
|
OP
|
$2,324.00
|
|
| Hospital Charge Code |
4124772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.75 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Aetna Managed Medicare |
$676.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.57
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.72
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,571.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.18
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
OP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.36 |
| Max. Negotiated Rate |
$2,504.90 |
| Rate for Payer: Aetna Commercial |
$2,450.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,341.54
|
| Rate for Payer: Aetna Managed Medicare |
$762.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,769.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,361.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,306.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.04
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,504.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,523.68
|
| Rate for Payer: Health EOS Commercial |
$2,423.22
|
| Rate for Payer: HFN Commercial |
$2,504.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,042.04
|
| Rate for Payer: Multiplan Commercial |
$2,178.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,633.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,504.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.13
|
| Rate for Payer: Quartz Commercial |
$1,769.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,633.63
|
| Rate for Payer: The Alliance Commercial |
$1,361.36
|
| Rate for Payer: WEA Trust Commercial |
$1,497.50
|
| Rate for Payer: WPS Commercial |
$2,016.65
|
|
|
CDS KNEE ARTHROSCOPY BOX DYNJ900876M
|
Facility
|
IP
|
$2,618.00
|
|
| Hospital Charge Code |
4124763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,334.13 |
| Max. Negotiated Rate |
$2,504.90 |
| Rate for Payer: Aetna Commercial |
$2,450.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,341.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,443.04
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cigna Commercial |
$2,504.90
|
| Rate for Payer: Health EOS Commercial |
$2,423.22
|
| Rate for Payer: HFN Commercial |
$2,504.90
|
| Rate for Payer: Multiplan Commercial |
$2,178.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,504.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.13
|
| Rate for Payer: Quartz Commercial |
$1,633.63
|
| Rate for Payer: WEA Trust Commercial |
$1,497.50
|
| Rate for Payer: WPS Commercial |
$2,016.65
|
|
|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
IP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,498.85
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
|
CDS LOWER EXTREMITY BOX DYNJ900883
|
Facility
|
OP
|
$2,402.00
|
|
| Hospital Charge Code |
4124768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.46 |
| Max. Negotiated Rate |
$2,298.23 |
| Rate for Payer: Aetna Commercial |
$2,248.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.35
|
| Rate for Payer: Aetna Managed Medicare |
$699.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,623.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.98
|
| Rate for Payer: Cash Price |
$720.60
|
| Rate for Payer: Cigna Commercial |
$2,298.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,397.96
|
| Rate for Payer: Health EOS Commercial |
$2,223.29
|
| Rate for Payer: HFN Commercial |
$2,298.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,873.56
|
| Rate for Payer: Multiplan Commercial |
$1,998.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.06
|
| Rate for Payer: Quartz Commercial |
$1,623.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,498.85
|
| Rate for Payer: The Alliance Commercial |
$1,249.04
|
| Rate for Payer: WEA Trust Commercial |
$1,373.94
|
| Rate for Payer: WPS Commercial |
$1,850.26
|
|
