|
DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM 90700 - VFC
|
Professional
|
$20.83
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
5949633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$43.16 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Direct Admit Hospital Observ
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
3791433
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Direct Admit Hospital Observ
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
3791433
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$2,361.72 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$634.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Anthem Medicare Advantage |
$634.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$634.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$634.87
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$634.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$634.87
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,361.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$634.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$634.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$634.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$634.87
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$952.30
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$634.87
|
| Rate for Payer: The Alliance Commercial |
$152.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$634.87
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: Wellcare Medicare |
$634.87
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Direct Antiglobulin Test
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
973769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$226.72 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicaid |
$5.57
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicaid |
$5.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.57
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicaid |
$5.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WMAP Medicaid |
$5.57
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Direct Antiglobulin Test
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
973769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Direct Antiglobulin Test Cord
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
985763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Direct Antiglobulin Test Cord
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
985763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$226.72 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicaid |
$5.57
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicaid |
$5.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.57
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicaid |
$5.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WMAP Medicaid |
$5.57
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Direct Antiglobulin Test Heel
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
985764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$226.72 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicaid |
$5.57
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicaid |
$5.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.57
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicaid |
$5.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WMAP Medicaid |
$5.57
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Direct Antiglobulin Test Heel
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
985764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
DIRECT REPAIR OF ANEURYSM, PSEUDOANEURYSM, OR EXCISION (PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR WITHOUT PATCH GRAFT; FOR ANEURYSM, PSEUDOANEURYSM, AND ASSOCIATED OCCLUSIVE DISEASE, RADIAL OR ULNAR ARTERY
|
Facility
OP
|
$20,205.70
|
|
|
Service Code
|
CPT 35045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$20,205.70 |
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$14,272.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
|
|
DISCECTOMY, MICRO
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
DISCECTOMY, MICRO
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
discontinuedCDS MINOR PROCEDURE DYNJ900884
|
Facility
OP
|
$1,115.00
|
|
| Hospital Charge Code |
4124769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$4,460.00 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.90
|
| Rate for Payer: Aetna Managed Medicare |
$312.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$724.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$557.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$535.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.95
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$623.95
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$836.25
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$724.75
|
| Rate for Payer: Quartz Medicare Advantage |
$669.00
|
| Rate for Payer: The Alliance Commercial |
$4,460.00
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
discontinuedCDS MINOR PROCEDURE DYNJ900884
|
Facility
IP
|
$1,115.00
|
|
| Hospital Charge Code |
4124769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,025.80 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.95
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$669.00
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
discontinuedCUFF B/P CHILD REUSABLE
|
Facility
IP
|
$186.00
|
|
| Hospital Charge Code |
2963397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
discontinuedCUFF B/P CHILD REUSABLE
|
Facility
OP
|
$186.00
|
|
| Hospital Charge Code |
2963397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Discontinued - IABP Activity
|
Facility
OP
|
$1,321.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
3034567
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$369.88 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Aetna Managed Medicare |
$369.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$990.75
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$792.60
|
| Rate for Payer: The Alliance Commercial |
$5,284.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
Discontinued - IABP Activity
|
Facility
IP
|
$1,321.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
3034567
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$647.29 |
| Max. Negotiated Rate |
$1,215.32 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$792.60
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
|
DISCOVISC LATEX FREE
|
Facility
IP
|
$1,774.00
|
|
| Hospital Charge Code |
2974042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.26 |
| Max. Negotiated Rate |
$1,632.08 |
| Rate for Payer: Aetna Commercial |
$1,596.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.22
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$1,632.08
|
| Rate for Payer: Health EOS Commercial |
$1,578.86
|
| Rate for Payer: HFN Commercial |
$1,632.08
|
| Rate for Payer: Multiplan Commercial |
$1,419.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,064.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,632.08
|
| Rate for Payer: Quartz Beloit One Network |
$869.26
|
| Rate for Payer: Quartz Commercial |
$1,064.40
|
| Rate for Payer: WEA Trust Commercial |
$975.70
|
| Rate for Payer: WPS Commercial |
$1,314.00
|
|
|
DISCOVISC LATEX FREE
|
Facility
OP
|
$1,774.00
|
|
| Hospital Charge Code |
2974042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$496.72 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Aetna Commercial |
$1,596.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,525.64
|
| Rate for Payer: Aetna Managed Medicare |
$496.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$851.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.22
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$1,632.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$992.73
|
| Rate for Payer: Health EOS Commercial |
$1,578.86
|
| Rate for Payer: HFN Commercial |
$1,632.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,330.50
|
| Rate for Payer: Multiplan Commercial |
$1,419.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,064.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,632.08
|
| Rate for Payer: Quartz Beloit One Network |
$869.26
|
| Rate for Payer: Quartz Commercial |
$1,153.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,064.40
|
| Rate for Payer: The Alliance Commercial |
$7,096.00
|
| Rate for Payer: WEA Trust Commercial |
$975.70
|
| Rate for Payer: WPS Commercial |
$1,314.00
|
|
|
DISCOVISC LATEX FREE 8065183710
|
Facility
OP
|
$1,774.00
|
|
| Hospital Charge Code |
2972456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$496.72 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Aetna Commercial |
$1,596.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,525.64
|
| Rate for Payer: Aetna Managed Medicare |
$496.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,153.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$887.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$851.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.22
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$1,632.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$992.73
|
| Rate for Payer: Health EOS Commercial |
$1,578.86
|
| Rate for Payer: HFN Commercial |
$1,632.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,330.50
|
| Rate for Payer: Multiplan Commercial |
$1,419.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,064.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,632.08
|
| Rate for Payer: Quartz Beloit One Network |
$869.26
|
| Rate for Payer: Quartz Commercial |
$1,153.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,064.40
|
| Rate for Payer: The Alliance Commercial |
$7,096.00
|
| Rate for Payer: WEA Trust Commercial |
$975.70
|
| Rate for Payer: WPS Commercial |
$1,314.00
|
|
|
DISCOVISC LATEX FREE 8065183710
|
Facility
IP
|
$1,774.00
|
|
| Hospital Charge Code |
2972456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$869.26 |
| Max. Negotiated Rate |
$1,632.08 |
| Rate for Payer: Aetna Commercial |
$1,596.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$940.22
|
| Rate for Payer: Cash Price |
$532.20
|
| Rate for Payer: Cigna Commercial |
$1,632.08
|
| Rate for Payer: Health EOS Commercial |
$1,578.86
|
| Rate for Payer: HFN Commercial |
$1,632.08
|
| Rate for Payer: Multiplan Commercial |
$1,419.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,064.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,632.08
|
| Rate for Payer: Quartz Beloit One Network |
$869.26
|
| Rate for Payer: Quartz Commercial |
$1,064.40
|
| Rate for Payer: WEA Trust Commercial |
$975.70
|
| Rate for Payer: WPS Commercial |
$1,314.00
|
|
|
Disopyramide Lvl / 416
|
Professional
|
$337.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977927
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Disopyramide Lvl / 416
|
Facility
OP
|
$337.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977927
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$1,348.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$252.75
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Disopyramide Lvl / 416
|
Facility
IP
|
$337.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977927
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
