|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$20,785.44
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$5,697.30 |
| Max. Negotiated Rate |
$20,785.44 |
| Rate for Payer: Aetna Managed Medicare |
$5,697.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,103.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,576.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,998.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5,697.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,697.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,697.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,697.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,209.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,697.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,001.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,697.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,697.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,697.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,697.30
|
| Rate for Payer: NAPHCARE Commercial |
$8,545.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,697.30
|
| Rate for Payer: The Alliance Commercial |
$20,785.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,697.30
|
| Rate for Payer: United Healthcare PPO |
$11,678.57
|
| Rate for Payer: Wellcare Medicare |
$5,697.30
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$54,841.28
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$15,676.14 |
| Max. Negotiated Rate |
$54,841.28 |
| Rate for Payer: Aetna Managed Medicare |
$15,676.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,219.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,127.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,473.17
|
| Rate for Payer: Anthem Medicare Advantage |
$15,676.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,676.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,676.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,676.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,938.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,676.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,979.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,676.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,676.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,676.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,676.14
|
| Rate for Payer: NAPHCARE Commercial |
$23,514.21
|
| Rate for Payer: Quartz Medicare Advantage |
$15,676.14
|
| Rate for Payer: The Alliance Commercial |
$54,841.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,676.14
|
| Rate for Payer: United Healthcare PPO |
$31,124.93
|
| Rate for Payer: Wellcare Medicare |
$15,676.14
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$13,845.52
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$5,093.28 |
| Max. Negotiated Rate |
$13,845.52 |
| Rate for Payer: Aetna Managed Medicare |
$5,093.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,067.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,016.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,515.99
|
| Rate for Payer: Anthem Medicare Advantage |
$5,093.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,093.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,093.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,093.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,563.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,093.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,910.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,093.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,093.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,093.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,093.28
|
| Rate for Payer: NAPHCARE Commercial |
$7,639.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5,093.28
|
| Rate for Payer: The Alliance Commercial |
$13,845.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,093.28
|
| Rate for Payer: United Healthcare PPO |
$7,715.71
|
| Rate for Payer: Wellcare Medicare |
$5,093.28
|
|
|
Acute Peritoneal Dialysis
|
Facility
|
IP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$1,211.83 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,483.87
|
| Rate for Payer: WEA Trust Commercial |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
Acute Peritoneal Dialysis
|
Facility
|
OP
|
$2,378.00
|
|
| Hospital Charge Code |
3603561
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$692.47 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Aetna Managed Medicare |
$692.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,384.00
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,854.84
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,607.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,483.87
|
| Rate for Payer: The Alliance Commercial |
$1,236.56
|
| Rate for Payer: United Healthcare PPO |
$1,854.84
|
| Rate for Payer: WEA Trust Commercial |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
Acylcarnitines Quantitative
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$26.32
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$69.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$77.20
|
|
|
Acylcarnitines Quantitative
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.12
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$26.32
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$70.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: United Healthcare PPO |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: Wellcare Medicare |
$17.54
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Acylcarnitines Quantitative
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
977773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Adalimumab ADA
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$173.47
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Adalimumab ADA
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$274.66 |
| Rate for Payer: Aetna Commercial |
$274.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$274.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$263.10
|
| Rate for Payer: HFN Commercial |
$274.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$274.66
|
| Rate for Payer: Quartz Beloit One Network |
$127.21
|
| Rate for Payer: Quartz Commercial |
$164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Adalimumab ADA
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$187.93
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$216.84
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Adalimumab Drug Levels
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$173.47
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
Adalimumab Drug Levels
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$274.66 |
| Rate for Payer: Aetna Commercial |
$274.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$274.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$263.10
|
| Rate for Payer: HFN Commercial |
$274.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$274.66
|
| Rate for Payer: Quartz Beloit One Network |
$127.21
|
| Rate for Payer: Quartz Commercial |
$164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Adalimumab Drug Levels
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Aetna Commercial |
$260.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.64
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cigna Commercial |
$265.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$257.32
|
| Rate for Payer: HFN Commercial |
$265.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$231.30
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$265.99
|
| Rate for Payer: Quartz Beloit One Network |
$141.67
|
| Rate for Payer: Quartz Commercial |
$187.93
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$216.84
|
| Rate for Payer: WEA Trust Commercial |
$159.02
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$214.14
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Managed Medicare |
$32.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Anthem Medicare Advantage |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.09
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.09
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: NAPHCARE Commercial |
$48.14
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$263.64
|
| Rate for Payer: Quartz Medicare Advantage |
$32.09
|
| Rate for Payer: The Alliance Commercial |
$128.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.09
|
| Rate for Payer: United Healthcare PPO |
$304.20
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: Wellcare Medicare |
$32.09
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
ADAMTS13 Activity w/ Rlx to Inhibitor
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
5184659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$385.32 |
| Rate for Payer: Aetna Commercial |
$385.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Managed Medicare |
$32.09
|
| Rate for Payer: Anthem Medicare Advantage |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.09
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$385.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.09
|
| Rate for Payer: Health EOS Commercial |
$369.10
|
| Rate for Payer: HFN Commercial |
$385.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: NAPHCARE Commercial |
$48.14
|
| Rate for Payer: Preferred Network Access Commercial |
$385.32
|
| Rate for Payer: Quartz Beloit One Network |
$178.46
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$32.09
|
| Rate for Payer: The Alliance Commercial |
$126.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.09
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$141.22
|
|
|
.ADAMTS13 Inhibitor
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
.ADAMTS13 Inhibitor
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Aetna Commercial |
$256.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$256.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$246.06
|
| Rate for Payer: HFN Commercial |
$256.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$256.88
|
| Rate for Payer: Quartz Beloit One Network |
$118.98
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$52.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$58.89
|
|
|
.ADAMTS13 Inhibitor
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
6219292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.22
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$53.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: United Healthcare PPO |
$202.80
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: Wellcare Medicare |
$13.38
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
ADAPTER 24F Y-PORT FEEDING TUBE M00580651
|
Facility
|
IP
|
$197.00
|
|
| Hospital Charge Code |
4266108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
ADAPTER 24F Y-PORT FEEDING TUBE M00580651
|
Facility
|
OP
|
$197.00
|
|
| Hospital Charge Code |
4266108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$57.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.66
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$122.93
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$122.93
|
| Rate for Payer: The Alliance Commercial |
$102.44
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
ADAPTER ADLOCKING TITANIUM PD CATHETER(2 PC) 5C4129
|
Facility
|
OP
|
$3,149.00
|
|
| Hospital Charge Code |
4519869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.99 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Aetna Managed Medicare |
$916.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,637.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.72
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,456.22
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,964.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$2,128.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,964.98
|
| Rate for Payer: The Alliance Commercial |
$1,637.48
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
|
ADAPTER ADLOCKING TITANIUM PD CATHETER(2 PC) 5C4129
|
Facility
|
IP
|
$3,149.00
|
|
| Hospital Charge Code |
4519869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,604.73 |
| Max. Negotiated Rate |
$3,012.96 |
| Rate for Payer: Aetna Commercial |
$2,947.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.73
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,012.96
|
| Rate for Payer: Health EOS Commercial |
$2,914.71
|
| Rate for Payer: HFN Commercial |
$3,012.96
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.73
|
| Rate for Payer: Quartz Commercial |
$1,964.98
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,425.67
|
|
|
ADAPTER ANES CIRCUIT OXYGEN
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
2974458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
