|
Level V - surgical pathology, gross and microscopic examination adrenal, resection bone - biopsy/curettings bone fragment(s), pathologic fracture brain, biopsy brain/meninges, tumor resection breast, excision of lesion, requiring microscopic evaluation of surgical margins breast, mastectomy - partial/simple cervix, conization colon, segmental resection, other than for tumor extremity, amputation, non-traumatic eye, enucleation kidney, partial/total nephrectomy larynx, partial/total resection liver, biopsy - needle/wedge liver, partial resection lung, wedge biopsy lymph nodes, regional resection mediastinum, mass myocardium, biopsy odontogenic tumor ovary with or without tube, neoplastic pancreas, biopsy placenta, third trimester prostate, except radical resection salivary gland sentinel lymph node small intestine, resection, other than for tumor soft tissue mass (except lipoma) - biopsy/simple excision stomach - subtotal/total resection, other than for tumor testis, biopsy thymus, tumor thyroid, total/lobe ur
|
Facility
|
OP
|
$1,508.92
|
|
|
Service Code
|
CPT 88307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$377.23 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
|
|
Levetiracetam Level
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Levetiracetam Level
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Levetiracetam Level
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Levonorgestrel iu contracept J7298
|
Professional
|
Both
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$782.50 |
| Max. Negotiated Rate |
$1,689.48 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.42
|
| Rate for Payer: Anthem Commercial |
$1,039.25
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,689.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,263.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.04
|
| Rate for Payer: Health EOS Commercial |
$1,618.34
|
| Rate for Payer: HFN Commercial |
$1,689.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,555.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,555.24
|
| Rate for Payer: Multiplan Commercial |
$1,422.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,689.48
|
| Rate for Payer: Quartz Beloit One Network |
$782.50
|
| Rate for Payer: Quartz Commercial |
$1,013.69
|
| Rate for Payer: The Alliance Commercial |
$889.20
|
| Rate for Payer: United Healthcare Medicaid |
$1,263.22
|
| Rate for Payer: WEA Trust Commercial |
$978.12
|
| Rate for Payer: WPS Commercial |
$1,317.21
|
|
|
Levonorgestrel iu contracept J7298
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$497.95 |
| Max. Negotiated Rate |
$1,636.13 |
| Rate for Payer: Aetna Commercial |
$1,600.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.42
|
| Rate for Payer: Aetna Managed Medicare |
$497.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$889.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.55
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,636.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$995.22
|
| Rate for Payer: Health EOS Commercial |
$1,582.78
|
| Rate for Payer: HFN Commercial |
$1,636.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.80
|
| Rate for Payer: Multiplan Commercial |
$1,422.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,067.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,636.13
|
| Rate for Payer: Quartz Beloit One Network |
$871.42
|
| Rate for Payer: Quartz Commercial |
$1,155.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,067.04
|
| Rate for Payer: The Alliance Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$978.12
|
| Rate for Payer: WPS Commercial |
$1,317.21
|
|
|
Levonorgestrel iu contracept J7298
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$871.42 |
| Max. Negotiated Rate |
$1,636.13 |
| Rate for Payer: Aetna Commercial |
$1,600.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.55
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,636.13
|
| Rate for Payer: Health EOS Commercial |
$1,582.78
|
| Rate for Payer: HFN Commercial |
$1,636.13
|
| Rate for Payer: Multiplan Commercial |
$1,422.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,636.13
|
| Rate for Payer: Quartz Beloit One Network |
$871.42
|
| Rate for Payer: Quartz Commercial |
$1,067.04
|
| Rate for Payer: WEA Trust Commercial |
$978.12
|
| Rate for Payer: WPS Commercial |
$1,317.21
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$734.12 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Aetna Managed Medicare |
$734.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,310.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.22
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,966.38
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,704.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,573.10
|
| Rate for Payer: The Alliance Commercial |
$1,310.92
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,039.25 |
| Max. Negotiated Rate |
$2,490.75 |
| Rate for Payer: Aetna Commercial |
$2,490.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Anthem Commercial |
$1,039.25
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,490.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,263.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,573.10
|
| Rate for Payer: Health EOS Commercial |
$2,385.87
|
| Rate for Payer: HFN Commercial |
$2,490.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,547.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,547.66
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,153.61
|
| Rate for Payer: Quartz Commercial |
$1,494.45
|
| Rate for Payer: The Alliance Commercial |
$1,310.92
|
| Rate for Payer: United Healthcare Medicaid |
$1,263.22
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,284.70 |
| Max. Negotiated Rate |
$2,412.09 |
| Rate for Payer: Aetna Commercial |
$2,359.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,254.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,389.58
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,412.09
|
| Rate for Payer: Health EOS Commercial |
$2,333.44
|
| Rate for Payer: HFN Commercial |
$2,412.09
|
| Rate for Payer: Multiplan Commercial |
$2,097.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,412.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.70
|
| Rate for Payer: Quartz Commercial |
$1,573.10
|
| Rate for Payer: WEA Trust Commercial |
$1,442.01
|
| Rate for Payer: WPS Commercial |
$1,941.93
|
|
|
LHC Coronaries/BPG w/wo LV
|
Facility
|
IP
|
$21,101.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
3052499
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,753.07 |
| Max. Negotiated Rate |
$20,189.44 |
| Rate for Payer: Aetna Commercial |
$19,750.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,872.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,630.87
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cigna Commercial |
$20,189.44
|
| Rate for Payer: Health EOS Commercial |
$19,531.09
|
| Rate for Payer: HFN Commercial |
$20,189.44
|
| Rate for Payer: Multiplan Commercial |
$17,556.03
|
| Rate for Payer: Preferred Network Access Commercial |
$20,189.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,753.07
|
| Rate for Payer: Quartz Commercial |
$13,167.02
|
| Rate for Payer: WEA Trust Commercial |
$12,069.77
|
| Rate for Payer: WPS Commercial |
$16,254.10
|
|
|
LHC Coronaries/BPG w/wo LV
|
Facility
|
OP
|
$21,101.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
3052499
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$20,189.44 |
| Rate for Payer: Aetna Commercial |
$19,750.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,872.73
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,630.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cigna Commercial |
$20,189.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$19,531.09
|
| Rate for Payer: HFN Commercial |
$20,189.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$17,556.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$20,189.44
|
| Rate for Payer: Quartz Beloit One Network |
$10,753.07
|
| Rate for Payer: Quartz Commercial |
$14,264.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$12,069.77
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$16,254.10
|
|
|
LHC Coronaries w/wo LV
|
Facility
|
IP
|
$19,353.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
3052498
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,862.29 |
| Max. Negotiated Rate |
$18,516.95 |
| Rate for Payer: Aetna Commercial |
$18,114.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,309.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,667.37
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cigna Commercial |
$18,516.95
|
| Rate for Payer: Health EOS Commercial |
$17,913.14
|
| Rate for Payer: HFN Commercial |
$18,516.95
|
| Rate for Payer: Multiplan Commercial |
$16,101.70
|
| Rate for Payer: Preferred Network Access Commercial |
$18,516.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,862.29
|
| Rate for Payer: Quartz Commercial |
$12,076.27
|
| Rate for Payer: WEA Trust Commercial |
$11,069.92
|
| Rate for Payer: WPS Commercial |
$14,907.62
|
|
|
LHC Coronaries w/wo LV
|
Facility
|
OP
|
$19,353.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
3052498
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$18,516.95 |
| Rate for Payer: Aetna Commercial |
$18,114.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,309.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,667.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cigna Commercial |
$18,516.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$17,913.14
|
| Rate for Payer: HFN Commercial |
$18,516.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$16,101.70
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$18,516.95
|
| Rate for Payer: Quartz Beloit One Network |
$9,862.29
|
| Rate for Payer: Quartz Commercial |
$13,082.63
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$11,069.92
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$14,907.62
|
|
|
LHC w/wo LV
|
Facility
|
IP
|
$18,729.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
3052492
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,544.30 |
| Max. Negotiated Rate |
$17,919.91 |
| Rate for Payer: Aetna Commercial |
$17,530.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,751.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,323.42
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cigna Commercial |
$17,919.91
|
| Rate for Payer: Health EOS Commercial |
$17,335.56
|
| Rate for Payer: HFN Commercial |
$17,919.91
|
| Rate for Payer: Multiplan Commercial |
$15,582.53
|
| Rate for Payer: Preferred Network Access Commercial |
$17,919.91
|
| Rate for Payer: Quartz Beloit One Network |
$9,544.30
|
| Rate for Payer: Quartz Commercial |
$11,686.90
|
| Rate for Payer: WEA Trust Commercial |
$10,712.99
|
| Rate for Payer: WPS Commercial |
$14,426.95
|
|
|
LHC w/wo LV
|
Facility
|
OP
|
$18,729.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
3052492
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Aetna Commercial |
$17,530.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,751.22
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,323.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cigna Commercial |
$17,919.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,900.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$17,335.56
|
| Rate for Payer: HFN Commercial |
$17,919.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$15,582.53
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17,919.91
|
| Rate for Payer: Quartz Beloit One Network |
$9,544.30
|
| Rate for Payer: Quartz Commercial |
$12,660.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$10,712.99
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$14,426.95
|
|
|
LH Labs, Stone Analysis
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 82360
|
| Hospital Charge Code |
4590610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$53.54 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.22
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$53.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: United Healthcare PPO |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.38
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
LH Labs, Stone Analysis
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 82360
|
| Hospital Charge Code |
4590610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
LH Pediatrics
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
4253747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
LH Pediatrics
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
4253747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.97
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$77.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: United Healthcare PPO |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: Wellcare Medicare |
$19.26
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
LH Pediatrics
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
4253747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$76.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$84.75
|
|
|
Lidocaine 1% 200mg/20ml MDV [Med]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
5415017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Lidocaine 1% 200mg/20ml MDV [Med]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
5415017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.04
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$0.07
|
|
|
Lidocaine 1% 300mg/30mL PF SDV (MED)
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
5813652
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Lidocaine 1% 300mg/30mL PF SDV (MED)
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
5813652
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
