|
ET intubation - Resuscitation at Birth:
|
Facility
|
IP
|
$344.00
|
|
| Hospital Charge Code |
3000343
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$214.66
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
ET intubation - Resuscitation at Birth:
|
Facility
|
OP
|
$344.00
|
|
| Hospital Charge Code |
3000343
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$100.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.21
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$232.54
|
| Rate for Payer: Quartz Medicare Advantage |
$214.66
|
| Rate for Payer: The Alliance Commercial |
$178.88
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
Etonogestrel implant system J7307 man
|
Facility
|
IP
|
$1,929.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
3373607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$983.02 |
| Max. Negotiated Rate |
$1,845.67 |
| Rate for Payer: Aetna Commercial |
$1,805.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,725.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,063.26
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna Commercial |
$1,845.67
|
| Rate for Payer: Health EOS Commercial |
$1,785.48
|
| Rate for Payer: HFN Commercial |
$1,845.67
|
| Rate for Payer: Multiplan Commercial |
$1,604.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,845.67
|
| Rate for Payer: Quartz Beloit One Network |
$983.02
|
| Rate for Payer: Quartz Commercial |
$1,203.70
|
| Rate for Payer: WEA Trust Commercial |
$1,103.39
|
| Rate for Payer: WPS Commercial |
$1,485.91
|
|
|
Etonogestrel implant system J7307 man
|
Facility
|
OP
|
$1,929.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
3373607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$561.72 |
| Max. Negotiated Rate |
$1,845.67 |
| Rate for Payer: Aetna Commercial |
$1,805.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,725.30
|
| Rate for Payer: Aetna Managed Medicare |
$561.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,304.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,003.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$962.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,063.26
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna Commercial |
$1,845.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,122.68
|
| Rate for Payer: Health EOS Commercial |
$1,785.48
|
| Rate for Payer: HFN Commercial |
$1,845.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,504.62
|
| Rate for Payer: Multiplan Commercial |
$1,604.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,845.67
|
| Rate for Payer: Quartz Beloit One Network |
$983.02
|
| Rate for Payer: Quartz Commercial |
$1,304.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,203.70
|
| Rate for Payer: The Alliance Commercial |
$1,003.08
|
| Rate for Payer: WEA Trust Commercial |
$1,103.39
|
| Rate for Payer: WPS Commercial |
$1,485.91
|
|
|
Etonogestrel implant system J7307 man
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
3373607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$882.71 |
| Max. Negotiated Rate |
$1,905.85 |
| Rate for Payer: Aetna Commercial |
$1,905.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,725.30
|
| Rate for Payer: Anthem Commercial |
$1,020.82
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna Commercial |
$1,905.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,326.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,203.70
|
| Rate for Payer: Health EOS Commercial |
$1,825.61
|
| Rate for Payer: HFN Commercial |
$1,905.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,527.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,527.67
|
| Rate for Payer: Multiplan Commercial |
$1,604.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,905.85
|
| Rate for Payer: Quartz Beloit One Network |
$882.71
|
| Rate for Payer: Quartz Commercial |
$1,143.51
|
| Rate for Payer: The Alliance Commercial |
$1,003.08
|
| Rate for Payer: United Healthcare Medicaid |
$1,326.37
|
| Rate for Payer: WEA Trust Commercial |
$1,103.39
|
| Rate for Payer: WPS Commercial |
$1,485.91
|
|
|
E.T. Tube 2.0 - 8.0
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3149564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
E.T. Tube 2.0 - 8.0
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3149564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Euflexxa 1 Unit = 1 Unit Charge
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
5386676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,332.60 |
| Max. Negotiated Rate |
$2,502.03 |
| Rate for Payer: Aetna Commercial |
$2,447.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.39
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,502.03
|
| Rate for Payer: Health EOS Commercial |
$2,420.44
|
| Rate for Payer: HFN Commercial |
$2,502.03
|
| Rate for Payer: Multiplan Commercial |
$2,175.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.60
|
| Rate for Payer: Quartz Commercial |
$1,631.76
|
| Rate for Payer: WEA Trust Commercial |
$1,495.78
|
| Rate for Payer: WPS Commercial |
$2,014.33
|
|
|
Euflexxa 1 Unit = 1 Unit Charge
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
5386676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.07 |
| Max. Negotiated Rate |
$2,502.03 |
| Rate for Payer: Aetna Commercial |
$2,447.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.86
|
| Rate for Payer: Aetna Managed Medicare |
$102.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,767.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,359.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.41
|
| Rate for Payer: Anthem Medicare Advantage |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.07
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,502.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$102.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$102.07
|
| Rate for Payer: Health EOS Commercial |
$2,420.44
|
| Rate for Payer: HFN Commercial |
$2,502.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$102.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$102.07
|
| Rate for Payer: Multiplan Commercial |
$2,175.68
|
| Rate for Payer: NAPHCARE Commercial |
$153.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,332.60
|
| Rate for Payer: Quartz Commercial |
$1,767.74
|
| Rate for Payer: Quartz Medicare Advantage |
$102.07
|
| Rate for Payer: The Alliance Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.07
|
| Rate for Payer: WEA Trust Commercial |
$1,495.78
|
| Rate for Payer: Wellcare Medicare |
$102.07
|
| Rate for Payer: WPS Commercial |
$300.49
|
|
|
Euflexxa 1 Unit = 1 Unit Charge
|
Professional
|
Both
|
$2,615.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
5386676
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.07 |
| Max. Negotiated Rate |
$2,583.62 |
| Rate for Payer: Aetna Commercial |
$2,583.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,338.86
|
| Rate for Payer: Aetna Managed Medicare |
$102.07
|
| Rate for Payer: Anthem Medicare Advantage |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.07
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$2,583.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.20
|
| Rate for Payer: Health EOS Commercial |
$2,474.84
|
| Rate for Payer: HFN Commercial |
$2,583.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.07
|
| Rate for Payer: Multiplan Commercial |
$2,175.68
|
| Rate for Payer: NAPHCARE Commercial |
$153.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,583.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.62
|
| Rate for Payer: Quartz Commercial |
$1,550.17
|
| Rate for Payer: Quartz Medicare Advantage |
$102.07
|
| Rate for Payer: The Alliance Commercial |
$280.68
|
| Rate for Payer: United Healthcare Medicaid |
$109.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.07
|
| Rate for Payer: WEA Trust Commercial |
$1,495.78
|
| Rate for Payer: WPS Commercial |
$300.49
|
|
|
Euflexxa inj per dose J7323
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4422622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.07 |
| Max. Negotiated Rate |
$2,550.83 |
| Rate for Payer: Aetna Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Aetna Managed Medicare |
$102.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,802.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,386.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,330.87
|
| Rate for Payer: Anthem Medicare Advantage |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.07
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$102.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$102.07
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$102.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$102.07
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$153.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,550.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,358.59
|
| Rate for Payer: Quartz Commercial |
$1,802.22
|
| Rate for Payer: Quartz Medicare Advantage |
$102.07
|
| Rate for Payer: The Alliance Commercial |
$408.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.07
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: Wellcare Medicare |
$102.07
|
| Rate for Payer: WPS Commercial |
$300.49
|
|
|
Euflexxa inj per dose J7323
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4422622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,358.59 |
| Max. Negotiated Rate |
$2,550.83 |
| Rate for Payer: Aetna Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,550.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,358.59
|
| Rate for Payer: Quartz Commercial |
$1,663.58
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$2,053.62
|
|
|
Euflexxa inj per dose J7323
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
4422622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.07 |
| Max. Negotiated Rate |
$2,634.01 |
| Rate for Payer: Aetna Commercial |
$2,634.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Aetna Managed Medicare |
$102.07
|
| Rate for Payer: Anthem Medicare Advantage |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.07
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,634.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.20
|
| Rate for Payer: Health EOS Commercial |
$2,523.10
|
| Rate for Payer: HFN Commercial |
$2,634.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.07
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$153.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,634.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.96
|
| Rate for Payer: Quartz Commercial |
$1,580.40
|
| Rate for Payer: Quartz Medicare Advantage |
$102.07
|
| Rate for Payer: The Alliance Commercial |
$280.68
|
| Rate for Payer: United Healthcare Medicaid |
$109.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.07
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$300.49
|
|
|
EUSTACHIAN TUBE BALLOON SYSTEM ACCLARENT AERA EU061655
|
Facility
|
IP
|
$11,334.00
|
|
|
Service Code
|
HCPCS C9745
|
| Hospital Charge Code |
5306666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,775.81 |
| Max. Negotiated Rate |
$10,844.37 |
| Rate for Payer: Aetna Commercial |
$10,608.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,137.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,247.30
|
| Rate for Payer: Cash Price |
$3,400.20
|
| Rate for Payer: Cigna Commercial |
$10,844.37
|
| Rate for Payer: Health EOS Commercial |
$10,490.75
|
| Rate for Payer: HFN Commercial |
$10,844.37
|
| Rate for Payer: Multiplan Commercial |
$9,429.89
|
| Rate for Payer: Preferred Network Access Commercial |
$10,844.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,775.81
|
| Rate for Payer: Quartz Commercial |
$7,072.42
|
| Rate for Payer: WEA Trust Commercial |
$6,483.05
|
| Rate for Payer: WPS Commercial |
$8,730.58
|
|
|
EUSTACHIAN TUBE BALLOON SYSTEM ACCLARENT AERA EU061655
|
Facility
|
OP
|
$11,334.00
|
|
|
Service Code
|
HCPCS C9745
|
| Hospital Charge Code |
5306666
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,300.46 |
| Max. Negotiated Rate |
$10,844.37 |
| Rate for Payer: Aetna Commercial |
$10,608.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,137.13
|
| Rate for Payer: Aetna Managed Medicare |
$3,300.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,661.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,893.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,657.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,247.30
|
| Rate for Payer: Cash Price |
$3,400.20
|
| Rate for Payer: Cigna Commercial |
$10,844.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,596.39
|
| Rate for Payer: Health EOS Commercial |
$10,490.75
|
| Rate for Payer: HFN Commercial |
$10,844.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,840.52
|
| Rate for Payer: Multiplan Commercial |
$9,429.89
|
| Rate for Payer: NAPHCARE Commercial |
$7,072.42
|
| Rate for Payer: Preferred Network Access Commercial |
$10,844.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,775.81
|
| Rate for Payer: Quartz Commercial |
$7,661.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7,072.42
|
| Rate for Payer: The Alliance Commercial |
$5,893.68
|
| Rate for Payer: WEA Trust Commercial |
$6,483.05
|
| Rate for Payer: WPS Commercial |
$8,730.58
|
|
|
Evacuation of a subungual Hematoma
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
1190876
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$31.13
|
| Rate for Payer: Anthem Medicare Advantage |
$31.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.13
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.13
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.13
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$46.69
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: Quartz Medicare Advantage |
$31.13
|
| Rate for Payer: The Alliance Commercial |
$132.29
|
| Rate for Payer: United Healthcare Medicaid |
$37.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.13
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$140.07
|
|
|
EVACUATOR UROVAC BLADDER 730125 M0067301250
|
Facility
|
OP
|
$510.00
|
|
| Hospital Charge Code |
5306820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$487.97 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Aetna Managed Medicare |
$148.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.82
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.80
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: NAPHCARE Commercial |
$318.24
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$344.76
|
| Rate for Payer: Quartz Medicare Advantage |
$318.24
|
| Rate for Payer: The Alliance Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
EVACUATOR UROVAC BLADDER 730125 M0067301250
|
Facility
|
IP
|
$510.00
|
|
| Hospital Charge Code |
5306820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.90 |
| Max. Negotiated Rate |
$487.97 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$318.24
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
Evaluation of Speech Fluency - SLP TH Evaluation Chg
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 95251 GN,95
|
| Hospital Charge Code |
5585356
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Aetna Managed Medicare |
$293.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.07
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: NAPHCARE Commercial |
$628.37
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$680.73
|
| Rate for Payer: Quartz Medicare Advantage |
$628.37
|
| Rate for Payer: The Alliance Commercial |
$523.64
|
| Rate for Payer: United Healthcare PPO |
$785.46
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Fluency - SLP TH Evaluation Chg
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 95251 GN,95
|
| Hospital Charge Code |
5585356
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$513.17 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Fluency - Speech Language Evaluation
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
3978011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$513.17 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Fluency - Speech Language Evaluation
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 92521 GN
|
| Hospital Charge Code |
3978011
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Aetna Managed Medicare |
$293.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.07
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: NAPHCARE Commercial |
$628.37
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$680.73
|
| Rate for Payer: Quartz Medicare Advantage |
$628.37
|
| Rate for Payer: The Alliance Commercial |
$523.64
|
| Rate for Payer: United Healthcare PPO |
$785.46
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Sound Production - SLP TH Evaluation Chg
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 92522 GN,95
|
| Hospital Charge Code |
5585357
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Aetna Managed Medicare |
$293.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.07
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: NAPHCARE Commercial |
$628.37
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$680.73
|
| Rate for Payer: Quartz Medicare Advantage |
$628.37
|
| Rate for Payer: The Alliance Commercial |
$523.64
|
| Rate for Payer: United Healthcare PPO |
$785.46
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Sound Production - SLP TH Evaluation Chg
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 92522 GN,95
|
| Hospital Charge Code |
5585357
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$513.17 |
| Max. Negotiated Rate |
$963.50 |
| Rate for Payer: Aetna Commercial |
$942.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.06
|
| Rate for Payer: Cash Price |
$302.10
|
| Rate for Payer: Cigna Commercial |
$963.50
|
| Rate for Payer: Health EOS Commercial |
$932.08
|
| Rate for Payer: HFN Commercial |
$963.50
|
| Rate for Payer: Multiplan Commercial |
$837.82
|
| Rate for Payer: Preferred Network Access Commercial |
$963.50
|
| Rate for Payer: Quartz Beloit One Network |
$513.17
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: WEA Trust Commercial |
$576.00
|
| Rate for Payer: WPS Commercial |
$775.69
|
|
|
Evaluation of Speech Sound Production - Speech Language Evaluation
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 92522 GN
|
| Hospital Charge Code |
3978010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
