|
CLAVICLE RESECTION, DISTAL
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2959932
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
Clean Out Mastoid Cavity 6922050
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 69220 50
|
| Hospital Charge Code |
3798676
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.34 |
| Max. Negotiated Rate |
$358.64 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.51
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.19
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: The Alliance Commercial |
$188.76
|
| Rate for Payer: United Healthcare Medicaid |
$45.34
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
OP
|
$2,194.75
|
|
|
Service Code
|
EAPG 00262
|
| Min. Negotiated Rate |
$2,110.33 |
| Max. Negotiated Rate |
$2,194.75 |
| Rate for Payer: Anthem Medicaid |
$2,110.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,110.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,110.33
|
| Rate for Payer: Dean Health Medicaid |
$2,110.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,110.33
|
| Rate for Payer: Managed Health Services Medicaid |
$2,194.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,110.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,110.33
|
| Rate for Payer: United Healthcare Medicaid |
$2,110.33
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$8,329.89
|
|
|
Service Code
|
APR-DRG 0951
|
| Min. Negotiated Rate |
$7,399.13 |
| Max. Negotiated Rate |
$8,329.89 |
| Rate for Payer: Anthem Medicaid |
$7,976.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,976.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,976.33
|
| Rate for Payer: Dean Health Medicaid |
$7,976.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,399.13
|
| Rate for Payer: Managed Health Services Medicaid |
$8,329.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,976.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,976.33
|
| Rate for Payer: United Healthcare Medicaid |
$7,976.33
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$14,116.98
|
|
|
Service Code
|
APR-DRG 0953
|
| Min. Negotiated Rate |
$12,539.58 |
| Max. Negotiated Rate |
$14,116.98 |
| Rate for Payer: Anthem Medicaid |
$13,517.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,517.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,517.79
|
| Rate for Payer: Dean Health Medicaid |
$13,517.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,539.58
|
| Rate for Payer: Managed Health Services Medicaid |
$14,116.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,517.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,517.79
|
| Rate for Payer: United Healthcare Medicaid |
$13,517.79
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$29,286.16
|
|
|
Service Code
|
APR-DRG 0954
|
| Min. Negotiated Rate |
$26,013.79 |
| Max. Negotiated Rate |
$29,286.16 |
| Rate for Payer: Anthem Medicaid |
$28,043.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,043.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,043.11
|
| Rate for Payer: Dean Health Medicaid |
$28,043.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,013.79
|
| Rate for Payer: Managed Health Services Medicaid |
$29,286.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,043.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,043.11
|
| Rate for Payer: United Healthcare Medicaid |
$28,043.11
|
|
|
CLEFT LIP AND PALATE REPAIR
|
Facility
|
IP
|
$8,855.99
|
|
|
Service Code
|
APR-DRG 0952
|
| Min. Negotiated Rate |
$7,866.45 |
| Max. Negotiated Rate |
$8,855.99 |
| Rate for Payer: Anthem Medicaid |
$8,480.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,480.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,480.10
|
| Rate for Payer: Dean Health Medicaid |
$8,480.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,866.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8,855.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,480.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,480.10
|
| Rate for Payer: United Healthcare Medicaid |
$8,480.10
|
|
|
CLEFT LIP & PALATE REPAIR
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959934
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
CLEFT LIP & PALATE REPAIR
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959934
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
CLEFT LIP REVISION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959933
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CLEFT LIP REVISION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959933
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Clindamycin 900mg vial [Med]
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
2974925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Clindamycin 900mg vial [Med]
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS S0077
|
| Hospital Charge Code |
2974925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Clindamycin Level
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$287.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| 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 |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$287.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$275.40
|
| Rate for Payer: HFN Commercial |
$287.51
|
| 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 |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$287.51
|
| Rate for Payer: Quartz Beloit One Network |
$133.16
|
| Rate for Payer: Quartz Commercial |
$172.50
|
| 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 |
$166.45
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Clindamycin Level
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| 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 |
$160.40
|
| 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 |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| 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 |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| 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 |
$226.98
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Clindamycin Level
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1038870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Clinical Information
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5432898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$482.14 |
| Rate for Payer: Aetna Commercial |
$482.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$482.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$461.84
|
| Rate for Payer: HFN Commercial |
$482.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$482.14
|
| Rate for Payer: Quartz Beloit One Network |
$223.31
|
| Rate for Payer: Quartz Commercial |
$289.29
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$210.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$234.25
|
|
|
Clinical Information
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5432898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$304.51
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
Clinical Information
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5432898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.37
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$329.89
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$212.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: United Healthcare PPO |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: Wellcare Medicare |
$53.24
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
CLIP 11MM ASSURANCE 00711182
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6204979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 11MM ASSURANCE 00711182
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6204979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$320.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| Rate for Payer: Quartz Medicare Advantage |
$686.40
|
| Rate for Payer: The Alliance Commercial |
$572.00
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 13MM ASSURANCE 00711883
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
6217003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 13MM ASSURANCE 00711883
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6217003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$320.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| Rate for Payer: Quartz Medicare Advantage |
$686.40
|
| Rate for Payer: The Alliance Commercial |
$572.00
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
CLIP 16MM ASSURANCE 00711884
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
6204980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$320.32 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$320.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$858.00
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$686.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| Rate for Payer: Quartz Medicare Advantage |
$686.40
|
| Rate for Payer: The Alliance Commercial |
$572.00
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
