|
Adriamycin 10 mg Charge
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$44.93
|
| Rate for Payer: The Alliance Commercial |
$11.56
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$9.48
|
|
|
Adriamycin 10 mg Charge
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Adriamycin 10 mg Charge
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
2958978
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$71.14 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$2.89
|
| Rate for Payer: Anthem Medicare Advantage |
$2.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.89
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.79
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$4.34
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$2.89
|
| Rate for Payer: The Alliance Commercial |
$7.95
|
| Rate for Payer: United Healthcare Medicaid |
$2.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.89
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$9.48
|
|
|
Adrucil 500 mg Charge
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna Commercial |
$21.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$2.02
|
| Rate for Payer: Anthem Medicare Advantage |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.02
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.07
|
| Rate for Payer: Health EOS Commercial |
$20.82
|
| Rate for Payer: HFN Commercial |
$21.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$3.03
|
| Rate for Payer: Preferred Network Access Commercial |
$21.74
|
| Rate for Payer: Quartz Beloit One Network |
$10.07
|
| Rate for Payer: Quartz Commercial |
$13.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2.02
|
| Rate for Payer: The Alliance Commercial |
$5.55
|
| Rate for Payer: United Healthcare Medicaid |
$2.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.02
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$7.67
|
|
|
Adrucil 500 mg Charge
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
Adrucil 500 mg Charge
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J9190
|
| Hospital Charge Code |
2958948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.06
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$8.07
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$7.67
|
|
|
Adult Digital 02 Transducr D25
|
Facility
|
IP
|
$442.00
|
|
| Hospital Charge Code |
3101749
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Adult Digital 02 Transducr D25
|
Facility
|
OP
|
$442.00
|
|
| Hospital Charge Code |
3101749
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$128.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$298.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.24
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.76
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$275.81
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| Rate for Payer: Quartz Medicare Advantage |
$275.81
|
| Rate for Payer: The Alliance Commercial |
$229.84
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Adult Ezio
|
Facility
|
IP
|
$231.00
|
|
| Hospital Charge Code |
3040371
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
Adult Ezio
|
Facility
|
OP
|
$231.00
|
|
| Hospital Charge Code |
3040371
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.27 |
| 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 |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| 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: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| 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 |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
ADULT PREVENTIVE MEDICINE
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00876
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
Advanced Care Planning 99497
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
4598878
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$274.38 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$65.72
|
| Rate for Payer: Anthem Medicare Advantage |
$65.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.72
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.72
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.72
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$98.58
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: Quartz Medicare Advantage |
$65.72
|
| Rate for Payer: The Alliance Commercial |
$157.72
|
| Rate for Payer: United Healthcare Medicaid |
$65.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.72
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$180.72
|
|
|
Advanced Care Planning Ea Add 30 min 99498
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
4598877
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$258.78 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$63.24
|
| Rate for Payer: Anthem Medicare Advantage |
$63.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.24
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.24
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$258.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.24
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$94.86
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$63.24
|
| Rate for Payer: The Alliance Commercial |
$151.78
|
| Rate for Payer: United Healthcare Medicaid |
$65.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.24
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$173.92
|
|
|
AEP HEARING STATUS DETER BRDBAND STIMULI I&R -92651
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
5781703
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$211.66 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.66
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$286.62
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$330.72
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
AEP HEARING STATUS DETER BRDBAND STIMULI I&R -92651
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 92651
|
| Hospital Charge Code |
5781703
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$216.07 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$264.58
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
AEP SCR AUD POTENTIAL W/STIMULI AUTO ALYS -92650
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
5781702
|
|
Hospital Revenue Code
|
470
|
| 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
|
|
|
AEP SCR AUD POTENTIAL W/STIMULI AUTO ALYS -92650
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
5781702
|
|
Hospital Revenue Code
|
470
|
| 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: United Healthcare PPO |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Aerobe ID MALDI
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
6195681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$8.40
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Aerobe ID MALDI
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
6195681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Aerobe ID MALDI
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
6195681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Aerosol Inhalation 94640 - Admin Aerosol Inhalation Charge
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
3023775
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$21.06
|
| Rate for Payer: United Healthcare Medicaid |
$12.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$33.70
|
|
|
Aerosol Inhalation 94640 - Admin Aerosol Inhalation Charge
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
3023775
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Aerosol Inhalation 94640 - Admin Aerosol Inhalation Charge
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
3023775
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.87
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Aerosol Mask - Adult
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Aerosol Mask - Adult
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
