|
Hymovis Charge
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5204742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$907.12 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Aetna Managed Medicare |
$17.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$493.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$473.28
|
| Rate for Payer: Anthem Medicare Advantage |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.26
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.26
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$640.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17.26
|
| Rate for Payer: The Alliance Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.26
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: Wellcare Medicare |
$17.26
|
| Rate for Payer: WPS Commercial |
$43.77
|
|
|
Hymovis Charge
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5204742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$483.14 |
| Max. Negotiated Rate |
$907.12 |
| Rate for Payer: Aetna Commercial |
$887.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.58
|
| Rate for Payer: Cash Price |
$295.80
|
| Rate for Payer: Cigna Commercial |
$907.12
|
| Rate for Payer: Health EOS Commercial |
$877.54
|
| Rate for Payer: HFN Commercial |
$907.12
|
| Rate for Payer: Multiplan Commercial |
$788.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.60
|
| Rate for Payer: Preferred Network Access Commercial |
$907.12
|
| Rate for Payer: Quartz Beloit One Network |
$483.14
|
| Rate for Payer: Quartz Commercial |
$591.60
|
| Rate for Payer: WEA Trust Commercial |
$542.30
|
| Rate for Payer: WPS Commercial |
$730.33
|
|
|
Hymovis Injection 1 mg J7322
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5166612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$17.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Anthem Medicare Advantage |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.26
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.26
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17.26
|
| Rate for Payer: The Alliance Commercial |
$69.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.26
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: Wellcare Medicare |
$17.26
|
| Rate for Payer: WPS Commercial |
$43.77
|
|
|
Hymovis Injection 1 mg J7322
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5166612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Aetna Commercial |
$955.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$955.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.51
|
| Rate for Payer: Health EOS Commercial |
$915.46
|
| Rate for Payer: HFN Commercial |
$955.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.72
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$955.70
|
| Rate for Payer: Quartz Beloit One Network |
$442.64
|
| Rate for Payer: Quartz Commercial |
$573.42
|
| Rate for Payer: The Alliance Commercial |
$503.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.26
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$43.77
|
|
|
Hymovis Injection 1 mg J7322
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
HCPCS J7322
|
| Hospital Charge Code |
5166612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Hypersensitivity Pneumonitis Screen
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Hypersensitivity Pneumonitis Screen
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Hypersensitivity Pneumonitis Screen
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
1042939
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.80
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: HFN Commercial |
$116.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: The Alliance Commercial |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$30,868.00
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$11,103.48 |
| Max. Negotiated Rate |
$30,868.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,103.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,127.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,493.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,569.70
|
| Rate for Payer: Anthem Medicare Advantage |
$11,103.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,103.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,103.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,103.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,503.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,103.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,405.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,103.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,103.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,103.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,103.48
|
| Rate for Payer: NAPHCARE Commercial |
$16,655.22
|
| Rate for Payer: Quartz Medicare Advantage |
$11,103.48
|
| Rate for Payer: The Alliance Commercial |
$30,868.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,103.48
|
| Rate for Payer: United Healthcare PPO |
$17,442.97
|
| Rate for Payer: Wellcare Medicare |
$11,103.48
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$20,353.00
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$7,321.21 |
| Max. Negotiated Rate |
$20,353.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,321.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,735.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,060.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,458.50
|
| Rate for Payer: Anthem Medicare Advantage |
$7,321.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,321.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,321.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,321.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,719.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,321.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,693.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,321.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,321.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,321.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,321.21
|
| Rate for Payer: NAPHCARE Commercial |
$10,981.82
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.21
|
| Rate for Payer: The Alliance Commercial |
$20,353.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,321.21
|
| Rate for Payer: United Healthcare PPO |
$11,438.88
|
| Rate for Payer: Wellcare Medicare |
$7,321.21
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH CC
|
Facility
|
IP
|
$27,356.00
|
|
|
Service Code
|
MSDRG 078
|
| Min. Negotiated Rate |
$9,840.18 |
| Max. Negotiated Rate |
$27,356.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,840.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,399.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,402.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,583.56
|
| Rate for Payer: Anthem Medicare Advantage |
$9,840.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,840.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,840.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,840.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,299.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,840.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,829.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,840.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,840.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,840.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,840.18
|
| Rate for Payer: NAPHCARE Commercial |
$14,760.27
|
| Rate for Payer: Quartz Medicare Advantage |
$9,840.18
|
| Rate for Payer: The Alliance Commercial |
$27,356.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,840.18
|
| Rate for Payer: United Healthcare PPO |
$15,437.56
|
| Rate for Payer: Wellcare Medicare |
$9,840.18
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH MCC
|
Facility
|
IP
|
$40,489.00
|
|
|
Service Code
|
MSDRG 077
|
| Min. Negotiated Rate |
$14,564.44 |
| Max. Negotiated Rate |
$40,489.00 |
| Rate for Payer: Wellcare Medicare |
$14,564.44
|
| Rate for Payer: Aetna Managed Medicare |
$14,564.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,564.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,564.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,564.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,564.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,564.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,462.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,564.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,564.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,564.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,564.44
|
| Rate for Payer: NAPHCARE Commercial |
$21,846.66
|
| Rate for Payer: Quartz Medicare Advantage |
$14,564.44
|
| Rate for Payer: The Alliance Commercial |
$40,489.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,564.44
|
| Rate for Payer: United Healthcare PPO |
$22,936.97
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC
|
Facility
|
IP
|
$20,015.00
|
|
|
Service Code
|
MSDRG 079
|
| Min. Negotiated Rate |
$7,199.75 |
| Max. Negotiated Rate |
$20,015.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,199.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,199.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,199.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,199.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,199.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,199.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,445.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,199.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,199.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,199.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,199.75
|
| Rate for Payer: NAPHCARE Commercial |
$10,799.62
|
| Rate for Payer: Quartz Medicare Advantage |
$7,199.75
|
| Rate for Payer: The Alliance Commercial |
$20,015.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,199.75
|
| Rate for Payer: United Healthcare PPO |
$11,246.08
|
| Rate for Payer: Wellcare Medicare |
$7,199.75
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Facility
|
IP
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,309.37 |
| Max. Negotiated Rate |
$4,335.96 |
| Rate for Payer: Aetna Commercial |
$4,241.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,053.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,497.89
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,335.96
|
| Rate for Payer: Health EOS Commercial |
$4,194.57
|
| Rate for Payer: HFN Commercial |
$4,335.96
|
| Rate for Payer: Multiplan Commercial |
$3,770.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,827.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,335.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.37
|
| Rate for Payer: Quartz Commercial |
$2,827.80
|
| Rate for Payer: WEA Trust Commercial |
$2,592.15
|
| Rate for Payer: WPS Commercial |
$3,490.92
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Facility
|
OP
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$4,335.96 |
| Rate for Payer: Aetna Commercial |
$4,241.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,053.18
|
| Rate for Payer: Aetna Managed Medicare |
$584.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,193.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$970.93
|
| Rate for Payer: Anthem Medicaid |
$597.91
|
| Rate for Payer: Anthem Medicare Advantage |
$584.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,497.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$584.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$584.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,335.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$584.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$597.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.39
|
| Rate for Payer: Dean Health Medicaid |
$597.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$584.90
|
| Rate for Payer: Health EOS Commercial |
$4,194.57
|
| Rate for Payer: HFN Commercial |
$4,335.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,175.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$584.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$597.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$584.90
|
| Rate for Payer: Managed Health Services Medicaid |
$621.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$584.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$584.90
|
| Rate for Payer: Multiplan Commercial |
$3,770.40
|
| Rate for Payer: NAPHCARE Commercial |
$877.35
|
| Rate for Payer: Preferred Network Access Commercial |
$4,335.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$597.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.37
|
| Rate for Payer: Quartz Commercial |
$3,063.45
|
| Rate for Payer: Quartz Medicare Advantage |
$584.90
|
| Rate for Payer: The Alliance Commercial |
$2,339.60
|
| Rate for Payer: United Healthcare Medicaid |
$597.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$584.90
|
| Rate for Payer: United Healthcare PPO |
$3,534.75
|
| Rate for Payer: WEA Trust Commercial |
$2,592.15
|
| Rate for Payer: Wellcare Medicare |
$584.90
|
| Rate for Payer: WMAP Medicaid |
$597.91
|
| Rate for Payer: WPS Commercial |
$3,490.92
|
|
|
Hypertrophic Cardiomyopathy Multi-Gene Panel
|
Professional
|
Both
|
$4,713.00
|
|
|
Service Code
|
CPT 81439
|
| Hospital Charge Code |
6171717
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,064.70 |
| Max. Negotiated Rate |
$4,477.35 |
| Rate for Payer: Aetna Commercial |
$4,477.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,053.18
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cigna Commercial |
$4,477.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,356.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,827.80
|
| Rate for Payer: Health EOS Commercial |
$4,288.83
|
| Rate for Payer: HFN Commercial |
$4,477.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,064.70
|
| Rate for Payer: Multiplan Commercial |
$3,770.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,477.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,073.72
|
| Rate for Payer: Quartz Commercial |
$2,686.41
|
| Rate for Payer: The Alliance Commercial |
$2,356.50
|
| Rate for Payer: WEA Trust Commercial |
$2,592.15
|
| Rate for Payer: WPS Commercial |
$3,490.92
|
|
|
Hypoglycemic Panel, Qual
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| 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 |
$133.03
|
| 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 |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| 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 DHI/DHP/ASO |
$140.46
|
| 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 |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| 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 |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$188.25
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Hypoglycemic Panel, Qual
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Hypoglycemic Panel, Qual
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256232
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$238.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$238.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.60
|
| Rate for Payer: Health EOS Commercial |
$228.41
|
| Rate for Payer: HFN Commercial |
$238.45
|
| 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: Multiplan Commercial |
$200.80
|
| Rate for Payer: Preferred Network Access Commercial |
$238.45
|
| Rate for Payer: Quartz Beloit One Network |
$110.44
|
| Rate for Payer: Quartz Commercial |
$143.07
|
| Rate for Payer: The Alliance Commercial |
$125.50
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
HYPOSPADIAS DEFORMITY REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
HYPOSPADIAS DEFORMITY REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960127
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
OP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$3,258.08 |
| Max. Negotiated Rate |
$46,544.00 |
| Rate for Payer: Aetna Commercial |
$10,472.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,006.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,258.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,563.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,818.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,585.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,167.08
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$10,705.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,511.51
|
| Rate for Payer: Health EOS Commercial |
$10,356.04
|
| Rate for Payer: HFN Commercial |
$10,705.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,727.00
|
| Rate for Payer: Multiplan Commercial |
$9,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,705.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,701.64
|
| Rate for Payer: Quartz Commercial |
$7,563.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,981.60
|
| Rate for Payer: The Alliance Commercial |
$46,544.00
|
| Rate for Payer: WEA Trust Commercial |
$6,399.80
|
| Rate for Payer: WPS Commercial |
$8,618.79
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
IP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$5,701.64 |
| Max. Negotiated Rate |
$10,705.12 |
| Rate for Payer: Aetna Commercial |
$10,472.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,006.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,167.08
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$10,705.12
|
| Rate for Payer: Health EOS Commercial |
$10,356.04
|
| Rate for Payer: HFN Commercial |
$10,705.12
|
| Rate for Payer: Multiplan Commercial |
$9,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,705.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,701.64
|
| Rate for Payer: Quartz Commercial |
$6,981.60
|
| Rate for Payer: WEA Trust Commercial |
$6,399.80
|
| Rate for Payer: WPS Commercial |
$8,618.79
|
|
|
HYSTEROSCOPY
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
2960128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,996.75 |
| Max. Negotiated Rate |
$3,749.00 |
| Rate for Payer: Aetna Commercial |
$3,667.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.75
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,749.00
|
| Rate for Payer: Health EOS Commercial |
$3,626.75
|
| Rate for Payer: HFN Commercial |
$3,749.00
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,445.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,749.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.75
|
| Rate for Payer: Quartz Commercial |
$2,445.00
|
| Rate for Payer: WEA Trust Commercial |
$2,241.25
|
| Rate for Payer: WPS Commercial |
$3,018.35
|
|
|
HYSTEROSCOPY
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
2960128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,141.00 |
| Max. Negotiated Rate |
$16,300.00 |
| Rate for Payer: Aetna Commercial |
$3,667.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,141.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,648.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,037.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,956.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.75
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,749.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,280.37
|
| Rate for Payer: Health EOS Commercial |
$3,626.75
|
| Rate for Payer: HFN Commercial |
$3,749.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,056.25
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,445.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,749.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.75
|
| Rate for Payer: Quartz Commercial |
$2,648.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,445.00
|
| Rate for Payer: The Alliance Commercial |
$16,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,241.25
|
| Rate for Payer: WPS Commercial |
$3,018.35
|
|
