|
JOINT INJECTION INTERMEDIATE JOINT
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
5294615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$63.00
|
| Rate for Payer: The Alliance Commercial |
$420.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
JOINT INJECTION MAJOR JOINT
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
5294614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$142.80
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
JOINT INJECTION MAJOR JOINT
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
5294614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$66.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.18
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$142.80
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
JOINT INJECTION SACROILIAC JOINT
|
Facility
|
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5294638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$677.67 |
| Max. Negotiated Rate |
$1,272.36 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$829.80
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
JOINT INJECTION SACROILIAC JOINT
|
Facility
|
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5294638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$5,532.00 |
| Rate for Payer: Aetna Commercial |
$1,244.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.38
|
| Rate for Payer: Aetna Managed Medicare |
$387.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.99
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,272.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.93
|
| Rate for Payer: Health EOS Commercial |
$1,230.87
|
| Rate for Payer: HFN Commercial |
$1,272.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.25
|
| Rate for Payer: Multiplan Commercial |
$1,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$829.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.36
|
| Rate for Payer: Quartz Beloit One Network |
$677.67
|
| Rate for Payer: Quartz Commercial |
$898.95
|
| Rate for Payer: Quartz Medicare Advantage |
$829.80
|
| Rate for Payer: The Alliance Commercial |
$5,532.00
|
| Rate for Payer: WEA Trust Commercial |
$760.65
|
| Rate for Payer: WPS Commercial |
$1,024.39
|
|
|
Jones dressing - Treatments Done
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
3025942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Jones dressing - Treatments Done
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
3025942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.18
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$27.00
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
JRC Observation Per Hour
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040432
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
JRC Observation Per Hour
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040432
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,992.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,030.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,729.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.70
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: United Healthcare PPO |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Juven Nutritional Supplement
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
3031443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Juven Nutritional Supplement
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
3031443
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Kangaroo feeding pump - Devices and Equipment
|
Facility
|
IP
|
$215.00
|
|
| Hospital Charge Code |
3002382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$197.80 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
Kangaroo feeding pump - Devices and Equipment
|
Facility
|
OP
|
$215.00
|
|
| Hospital Charge Code |
3002382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$60.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.31
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$139.75
|
| Rate for Payer: Quartz Medicare Advantage |
$129.00
|
| Rate for Payer: The Alliance Commercial |
$860.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
Kappa/Lambda Light Chains Free
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1096799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$174.75
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Kappa/Lambda Light Chains Free
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1096799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Kappa/Lambda Light Chains Free
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1096799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$221.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$221.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.80
|
| Rate for Payer: Health EOS Commercial |
$212.03
|
| Rate for Payer: HFN Commercial |
$221.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Preferred Network Access Commercial |
$221.35
|
| Rate for Payer: Quartz Beloit One Network |
$102.52
|
| Rate for Payer: Quartz Commercial |
$132.81
|
| Rate for Payer: The Alliance Commercial |
$116.50
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Kappa/Lambda Light Chains Total, Urine
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
983297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$177.56 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$115.80
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$115.80
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
Kappa/Lambda Light Chains Total, Urine
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
983297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: The Alliance Commercial |
$96.50
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
| Rate for Payer: Aetna Commercial |
$183.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.80
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| Rate for Payer: HFN Commercial |
$183.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.01
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.35
|
| Rate for Payer: Quartz Beloit One Network |
$84.92
|
| Rate for Payer: Quartz Commercial |
$110.01
|
|
|
Kappa/Lambda Light Chains Total, Urine
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
983297
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$177.56 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.58
|
| Rate for Payer: Anthem Medicaid |
$14.05
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.00
|
| Rate for Payer: Dean Health Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.05
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$125.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$54.40
|
| Rate for Payer: United Healthcare Medicaid |
$14.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare PPO |
$144.75
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: WMAP Medicaid |
$14.05
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
KELLER FUNNEL 2 HA-005
|
Facility
|
OP
|
$1,882.00
|
|
| Hospital Charge Code |
5627669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
KELLER FUNNEL 2 HA-005
|
Facility
|
IP
|
$1,882.00
|
|
| Hospital Charge Code |
5627669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
Kenalog 10mg Charge
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4524852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Kenalog 10mg Charge
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4524852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.08
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.95
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Kenalog 10mg Charge
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
4524852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.43
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Kenalog JW Waste Charge
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS J3301 JW
|
| Hospital Charge Code |
5246655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.43
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
