|
Ciprofloxacin 0.3% Ophth Ointment 3.5 gm [Med]
|
Facility
|
OP
|
$589.00
|
|
| Hospital Charge Code |
2974922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.92 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Aetna Managed Medicare |
$164.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.60
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.75
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$382.85
|
| Rate for Payer: Quartz Medicare Advantage |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$2,356.00
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Ciprofloxacin 0.3% Ophth solution 5ml [Med]
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
2974923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.19
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Ciprofloxacin 0.3% Ophth solution 5ml [Med]
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
2974923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Ciprofloxacin Hydrochloride Ophth 0.3% Ointment [Med]
|
Facility
|
OP
|
$589.00
|
|
| Hospital Charge Code |
2974924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.92 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Aetna Managed Medicare |
$164.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.60
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.75
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$382.85
|
| Rate for Payer: Quartz Medicare Advantage |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$2,356.00
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
Ciprofloxacin Hydrochloride Ophth 0.3% Ointment [Med]
|
Facility
|
IP
|
$589.00
|
|
| Hospital Charge Code |
2974924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$541.88 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
CIRCUIT MRI 3 METER VENT
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2971345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CIRCUIT MRI 3 METER VENT
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2971345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
CIRCUIT PT HIGH FLOW PRECISION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2972442
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
CIRCUIT PT HIGH FLOW PRECISION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2972442
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
CIRCUIT PT LOW FLOW PRECISION FP-DPC-LOW
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2972443
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
CIRCUIT PT LOW FLOW PRECISION FP-DPC-LOW
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2972443
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$57,629.00
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$20,729.90 |
| Max. Negotiated Rate |
$57,629.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,729.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,316.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,734.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,000.48
|
| Rate for Payer: Anthem Medicare Advantage |
$20,729.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,729.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,729.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,729.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,633.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,729.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,034.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,729.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,729.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,729.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,729.90
|
| Rate for Payer: NAPHCARE Commercial |
$31,094.85
|
| Rate for Payer: Quartz Medicare Advantage |
$20,729.90
|
| Rate for Payer: The Alliance Commercial |
$57,629.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,729.90
|
| Rate for Payer: United Healthcare PPO |
$32,724.16
|
| Rate for Payer: Wellcare Medicare |
$20,729.90
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$29,076.00
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$10,458.92 |
| Max. Negotiated Rate |
$29,076.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,458.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,367.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,500.24
|
| Rate for Payer: Anthem Medicare Advantage |
$10,458.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,458.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,458.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,458.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,316.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,458.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,091.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,458.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,458.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,458.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,458.92
|
| Rate for Payer: NAPHCARE Commercial |
$15,688.38
|
| Rate for Payer: Quartz Medicare Advantage |
$10,458.92
|
| Rate for Payer: The Alliance Commercial |
$29,076.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,458.92
|
| Rate for Payer: United Healthcare PPO |
$16,419.77
|
| Rate for Payer: Wellcare Medicare |
$10,458.92
|
|
|
CIRCUMCISION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CIRCUMCISION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Circumcision - Family Care Center
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3732197
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$340.32 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$460.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.32
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$460.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
Circumcision - Family Care Center
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3732197
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$652.28 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.77
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$652.28
|
| Rate for Payer: Health EOS Commercial |
$631.01
|
| Rate for Payer: HFN Commercial |
$652.28
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: NAPHCARE Commercial |
$425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$652.28
|
| Rate for Payer: Quartz Beloit One Network |
$347.41
|
| Rate for Payer: Quartz Commercial |
$425.40
|
| Rate for Payer: WEA Trust Commercial |
$389.95
|
| Rate for Payer: WPS Commercial |
$525.16
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$8,052.80
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
|
|
CIRCUMCISION W/REGIONL BLOCK 54150
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3015023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$754.30 |
| Rate for Payer: Aetna Commercial |
$754.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.84
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$754.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.40
|
| Rate for Payer: Health EOS Commercial |
$722.54
|
| Rate for Payer: HFN Commercial |
$754.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.21
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$754.30
|
| Rate for Payer: Quartz Beloit One Network |
$349.36
|
| Rate for Payer: Quartz Commercial |
$452.58
|
| Rate for Payer: The Alliance Commercial |
$397.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.63
|
| Rate for Payer: WEA Trust Commercial |
$436.70
|
| Rate for Payer: WPS Commercial |
$588.12
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$27,731.00
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$9,975.02 |
| Max. Negotiated Rate |
$27,731.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,975.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$9,975.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,975.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,975.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,975.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,975.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,104.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,975.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,975.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,975.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,975.02
|
| Rate for Payer: NAPHCARE Commercial |
$14,962.53
|
| Rate for Payer: Quartz Medicare Advantage |
$9,975.02
|
| Rate for Payer: The Alliance Commercial |
$27,731.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,975.02
|
| Rate for Payer: United Healthcare PPO |
$15,651.61
|
| Rate for Payer: Wellcare Medicare |
$9,975.02
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$51,259.00
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$18,438.54 |
| Max. Negotiated Rate |
$51,259.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,438.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,281.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,875.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,333.76
|
| Rate for Payer: Anthem Medicare Advantage |
$18,438.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,438.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,438.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,438.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,563.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,438.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,362.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,438.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,438.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,438.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,438.54
|
| Rate for Payer: NAPHCARE Commercial |
$27,657.81
|
| Rate for Payer: Quartz Medicare Advantage |
$18,438.54
|
| Rate for Payer: The Alliance Commercial |
$51,259.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,438.54
|
| Rate for Payer: United Healthcare PPO |
$29,086.80
|
| Rate for Payer: Wellcare Medicare |
$18,438.54
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,120.00
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$6,517.90 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,517.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,056.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,774.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,236.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,517.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,517.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,363.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,517.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,055.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,517.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,517.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,517.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,517.90
|
| Rate for Payer: NAPHCARE Commercial |
$9,776.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,517.90
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,517.90
|
| Rate for Payer: United Healthcare PPO |
$10,163.68
|
| Rate for Payer: Wellcare Medicare |
$6,517.90
|
|
|
Citalopram Level
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$1,024.00
|
| Rate for Payer: United Healthcare PPO |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Citalopram Level
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Citalopram Level
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.60
|
| Rate for Payer: Health EOS Commercial |
$232.96
|
| Rate for Payer: HFN Commercial |
$243.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$243.20
|
| Rate for Payer: Quartz Beloit One Network |
$112.64
|
| Rate for Payer: Quartz Commercial |
$145.92
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
