|
EP Stim/Pace Post IV Drug Infusion +
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
3052510
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$329.93 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
EP Study W/Ablation for SVT
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
3052516
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,058.45 |
| Max. Negotiated Rate |
$7,619.96 |
| Rate for Payer: Aetna Commercial |
$7,454.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,123.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,389.76
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,619.96
|
| Rate for Payer: Health EOS Commercial |
$7,371.48
|
| Rate for Payer: HFN Commercial |
$7,619.96
|
| Rate for Payer: Multiplan Commercial |
$6,626.05
|
| Rate for Payer: Preferred Network Access Commercial |
$7,619.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,058.45
|
| Rate for Payer: Quartz Commercial |
$4,969.54
|
| Rate for Payer: WEA Trust Commercial |
$4,555.41
|
| Rate for Payer: WPS Commercial |
$6,134.67
|
|
|
EP Study W/Ablation for SVT
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
3052516
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,058.45 |
| Max. Negotiated Rate |
$110,028.80 |
| Rate for Payer: Aetna Commercial |
$7,454.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,123.00
|
| Rate for Payer: Aetna Managed Medicare |
$27,507.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,389.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,507.20
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,619.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,507.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,635.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,507.20
|
| Rate for Payer: Health EOS Commercial |
$7,371.48
|
| Rate for Payer: HFN Commercial |
$7,619.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102,326.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,507.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,507.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,507.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,507.20
|
| Rate for Payer: Multiplan Commercial |
$6,626.05
|
| Rate for Payer: NAPHCARE Commercial |
$41,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,619.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,058.45
|
| Rate for Payer: Quartz Commercial |
$5,383.66
|
| Rate for Payer: Quartz Medicare Advantage |
$27,507.20
|
| Rate for Payer: The Alliance Commercial |
$110,028.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,507.20
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$4,555.41
|
| Rate for Payer: Wellcare Medicare |
$27,507.20
|
| Rate for Payer: WPS Commercial |
$6,134.67
|
|
|
EP Study W/Ablation for V-Tach
|
Facility
|
OP
|
$10,627.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
3052517
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,415.52 |
| Max. Negotiated Rate |
$110,028.80 |
| Rate for Payer: Aetna Commercial |
$9,946.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,504.79
|
| Rate for Payer: Aetna Managed Medicare |
$27,507.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,857.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,507.20
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cigna Commercial |
$10,167.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,507.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,184.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,507.20
|
| Rate for Payer: Health EOS Commercial |
$9,836.35
|
| Rate for Payer: HFN Commercial |
$10,167.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102,326.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,507.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,507.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,507.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,507.20
|
| Rate for Payer: Multiplan Commercial |
$8,841.66
|
| Rate for Payer: NAPHCARE Commercial |
$41,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,167.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,415.52
|
| Rate for Payer: Quartz Commercial |
$7,183.85
|
| Rate for Payer: Quartz Medicare Advantage |
$27,507.20
|
| Rate for Payer: The Alliance Commercial |
$110,028.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,507.20
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$6,078.64
|
| Rate for Payer: Wellcare Medicare |
$27,507.20
|
| Rate for Payer: WPS Commercial |
$8,185.98
|
|
|
EP Study W/Ablation for V-Tach
|
Facility
|
IP
|
$10,627.00
|
|
|
Service Code
|
CPT 93654
|
| Hospital Charge Code |
3052517
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,415.52 |
| Max. Negotiated Rate |
$10,167.91 |
| Rate for Payer: Aetna Commercial |
$9,946.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,504.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,857.60
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cigna Commercial |
$10,167.91
|
| Rate for Payer: Health EOS Commercial |
$9,836.35
|
| Rate for Payer: HFN Commercial |
$10,167.91
|
| Rate for Payer: Multiplan Commercial |
$8,841.66
|
| Rate for Payer: Preferred Network Access Commercial |
$10,167.91
|
| Rate for Payer: Quartz Beloit One Network |
$5,415.52
|
| Rate for Payer: Quartz Commercial |
$6,631.25
|
| Rate for Payer: WEA Trust Commercial |
$6,078.64
|
| Rate for Payer: WPS Commercial |
$8,185.98
|
|
|
EP Study W/LA/CS Pacing & Recording +
|
Facility
|
OP
|
$1,341.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
4125519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$390.50 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$1,255.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,199.39
|
| Rate for Payer: Aetna Managed Medicare |
$390.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.16
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cigna Commercial |
$1,283.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$780.46
|
| Rate for Payer: Health EOS Commercial |
$1,241.23
|
| Rate for Payer: HFN Commercial |
$1,283.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,045.98
|
| Rate for Payer: Multiplan Commercial |
$1,115.71
|
| Rate for Payer: NAPHCARE Commercial |
$836.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,283.07
|
| Rate for Payer: Quartz Beloit One Network |
$683.37
|
| Rate for Payer: Quartz Commercial |
$906.52
|
| Rate for Payer: Quartz Medicare Advantage |
$836.78
|
| Rate for Payer: The Alliance Commercial |
$697.32
|
| Rate for Payer: WEA Trust Commercial |
$767.05
|
| Rate for Payer: WPS Commercial |
$1,032.97
|
|
|
EP Study W/LA/CS Pacing & Recording +
|
Facility
|
IP
|
$1,341.00
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
4125519
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$683.37 |
| Max. Negotiated Rate |
$1,283.07 |
| Rate for Payer: Aetna Commercial |
$1,255.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,199.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.16
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cigna Commercial |
$1,283.07
|
| Rate for Payer: Health EOS Commercial |
$1,241.23
|
| Rate for Payer: HFN Commercial |
$1,283.07
|
| Rate for Payer: Multiplan Commercial |
$1,115.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,283.07
|
| Rate for Payer: Quartz Beloit One Network |
$683.37
|
| Rate for Payer: Quartz Commercial |
$836.78
|
| Rate for Payer: WEA Trust Commercial |
$767.05
|
| Rate for Payer: WPS Commercial |
$1,032.97
|
|
|
EP STUDY W/PULM VEIN ABLATION (PVI)-AF
|
Facility
|
OP
|
$15,470.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
5464771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,883.51 |
| Max. Negotiated Rate |
$110,028.80 |
| Rate for Payer: Aetna Commercial |
$14,479.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,836.37
|
| Rate for Payer: Aetna Managed Medicare |
$27,507.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,527.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,507.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,507.20
|
| Rate for Payer: Cash Price |
$4,641.00
|
| Rate for Payer: Cash Price |
$4,641.00
|
| Rate for Payer: Cash Price |
$4,641.00
|
| Rate for Payer: Cigna Commercial |
$14,801.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,507.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,003.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,507.20
|
| Rate for Payer: Health EOS Commercial |
$14,319.03
|
| Rate for Payer: HFN Commercial |
$14,801.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102,326.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,507.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,507.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,507.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,507.20
|
| Rate for Payer: Multiplan Commercial |
$12,871.04
|
| Rate for Payer: NAPHCARE Commercial |
$41,260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,801.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,883.51
|
| Rate for Payer: Quartz Commercial |
$10,457.72
|
| Rate for Payer: Quartz Medicare Advantage |
$27,507.20
|
| Rate for Payer: The Alliance Commercial |
$110,028.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,507.20
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$8,848.84
|
| Rate for Payer: Wellcare Medicare |
$27,507.20
|
| Rate for Payer: WPS Commercial |
$11,916.54
|
|
|
EP STUDY W/PULM VEIN ABLATION (PVI)-AF
|
Facility
|
IP
|
$15,470.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
5464771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,883.51 |
| Max. Negotiated Rate |
$14,801.70 |
| Rate for Payer: Aetna Commercial |
$14,479.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,836.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,527.06
|
| Rate for Payer: Cash Price |
$4,641.00
|
| Rate for Payer: Cigna Commercial |
$14,801.70
|
| Rate for Payer: Health EOS Commercial |
$14,319.03
|
| Rate for Payer: HFN Commercial |
$14,801.70
|
| Rate for Payer: Multiplan Commercial |
$12,871.04
|
| Rate for Payer: Preferred Network Access Commercial |
$14,801.70
|
| Rate for Payer: Quartz Beloit One Network |
$7,883.51
|
| Rate for Payer: Quartz Commercial |
$9,653.28
|
| Rate for Payer: WEA Trust Commercial |
$8,848.84
|
| Rate for Payer: WPS Commercial |
$11,916.54
|
|
|
Erbitux 10 mg Charge
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
2958945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.43 |
| Max. Negotiated Rate |
$245.02 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$83.55
|
| Rate for Payer: Anthem Medicare Advantage |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.55
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.43
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.55
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$125.33
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$83.55
|
| Rate for Payer: The Alliance Commercial |
$229.77
|
| Rate for Payer: United Healthcare Medicaid |
$83.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.55
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.07
|
|
|
Erbitux 10 mg Charge
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
2958945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.55 |
| Max. Negotiated Rate |
$334.21 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$83.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.80
|
| Rate for Payer: Anthem Medicare Advantage |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.55
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$83.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$83.55
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$83.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$83.55
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$125.33
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$83.55
|
| Rate for Payer: The Alliance Commercial |
$334.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.55
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: Wellcare Medicare |
$83.55
|
| Rate for Payer: WPS Commercial |
$191.07
|
|
|
Erbitux 10 mg Charge
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
2958945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
Ertapenem 1gm vial [Med]
|
Facility
|
IP
|
$1,159.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
2974935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$590.63 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$723.22
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$892.78
|
|
|
Ertapenem 1gm vial [Med]
|
Facility
|
OP
|
$1,159.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
2974935
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Aetna Managed Medicare |
$337.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.37
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.02
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: NAPHCARE Commercial |
$723.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$783.48
|
| Rate for Payer: Quartz Medicare Advantage |
$723.22
|
| Rate for Payer: The Alliance Commercial |
$38.11
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$30.93
|
|
|
Erythrocytosis Evaluation
|
Facility
|
IP
|
$3,789.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
3135500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,930.87 |
| Max. Negotiated Rate |
$3,625.32 |
| Rate for Payer: Aetna Commercial |
$3,546.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,388.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,088.50
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna Commercial |
$3,625.32
|
| Rate for Payer: Health EOS Commercial |
$3,507.10
|
| Rate for Payer: HFN Commercial |
$3,625.32
|
| Rate for Payer: Multiplan Commercial |
$3,152.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,625.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,930.87
|
| Rate for Payer: Quartz Commercial |
$2,364.34
|
| Rate for Payer: WEA Trust Commercial |
$2,167.31
|
| Rate for Payer: WPS Commercial |
$2,918.67
|
|
|
Erythrocytosis Evaluation
|
Professional
|
Both
|
$3,789.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
3135500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$3,743.53 |
| Rate for Payer: Aetna Commercial |
$3,743.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,388.88
|
| Rate for Payer: Aetna Managed Medicare |
$13.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.87
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna Commercial |
$3,743.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,970.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.87
|
| Rate for Payer: Health EOS Commercial |
$3,585.91
|
| Rate for Payer: HFN Commercial |
$3,743.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$3,152.45
|
| Rate for Payer: NAPHCARE Commercial |
$20.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,743.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,733.85
|
| Rate for Payer: Quartz Commercial |
$2,246.12
|
| Rate for Payer: Quartz Medicare Advantage |
$13.87
|
| Rate for Payer: The Alliance Commercial |
$54.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.87
|
| Rate for Payer: WEA Trust Commercial |
$2,167.31
|
| Rate for Payer: WPS Commercial |
$61.04
|
|
|
Erythrocytosis Evaluation
|
Facility
|
OP
|
$3,789.00
|
|
|
Service Code
|
CPT 82820
|
| Hospital Charge Code |
3135500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$3,625.32 |
| Rate for Payer: Aetna Commercial |
$3,546.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,388.88
|
| Rate for Payer: Aetna Managed Medicare |
$13.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,088.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.87
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cash Price |
$1,136.70
|
| Rate for Payer: Cigna Commercial |
$3,625.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,205.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.87
|
| Rate for Payer: Health EOS Commercial |
$3,507.10
|
| Rate for Payer: HFN Commercial |
$3,625.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$3,152.45
|
| Rate for Payer: NAPHCARE Commercial |
$20.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,625.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,930.87
|
| Rate for Payer: Quartz Commercial |
$2,561.36
|
| Rate for Payer: Quartz Medicare Advantage |
$13.87
|
| Rate for Payer: The Alliance Commercial |
$55.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.87
|
| Rate for Payer: United Healthcare PPO |
$2,955.42
|
| Rate for Payer: WEA Trust Commercial |
$2,167.31
|
| Rate for Payer: Wellcare Medicare |
$13.87
|
| Rate for Payer: WPS Commercial |
$2,918.67
|
|
|
Erythropoietin Level
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
977936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Erythropoietin Level
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
977936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.54 |
| Max. Negotiated Rate |
$380.38 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.54
|
| Rate for Payer: Anthem Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.54
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$380.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.54
|
| Rate for Payer: Health EOS Commercial |
$364.36
|
| Rate for Payer: HFN Commercial |
$380.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$29.31
|
| Rate for Payer: Preferred Network Access Commercial |
$380.38
|
| Rate for Payer: Quartz Beloit One Network |
$176.18
|
| Rate for Payer: Quartz Commercial |
$228.23
|
| Rate for Payer: Quartz Medicare Advantage |
$19.54
|
| Rate for Payer: The Alliance Commercial |
$77.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.54
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$85.98
|
|
|
Erythropoietin Level
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
977936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.54 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.44
|
| Rate for Payer: Anthem Medicare Advantage |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.54
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.54
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$29.31
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$19.54
|
| Rate for Payer: The Alliance Commercial |
$78.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.54
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$19.54
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Escitalopram Lvl
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1040879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| 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 |
$61.73
|
| 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 |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| 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 |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| 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 |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Escitalopram Lvl
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1040879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| 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 |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$106.00
|
| Rate for Payer: HFN Commercial |
$110.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$110.66
|
| Rate for Payer: Quartz Beloit One Network |
$51.25
|
| Rate for Payer: Quartz Commercial |
$66.39
|
| 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 |
$64.06
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Escitalopram Lvl
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
1040879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
ESMARK BANDAGE 4INX9 FT STERILE DYNJ05916H (SUB)/961650 (SUB)
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
4858710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
ESMARK BANDAGE 4INX9 FT STERILE DYNJ05916H (SUB)/961650 (SUB)
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
4858710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
