|
Molecule Nucleic Amp IgVh
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$91.80
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Molecule Nucleic Amp IgVh
|
Professional
|
Both
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.80
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: HFN Commercial |
$145.35
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Molecule Nucleic Amp IgVh
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Mometasone (Sinuva) 1350 mg Implant J7402
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
HCPCS J7402
|
| Hospital Charge Code |
6174160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,821.82 |
| Max. Negotiated Rate |
$3,420.56 |
| Rate for Payer: Aetna Commercial |
$3,346.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,197.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,970.54
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,420.56
|
| Rate for Payer: Health EOS Commercial |
$3,309.02
|
| Rate for Payer: HFN Commercial |
$3,420.56
|
| Rate for Payer: Multiplan Commercial |
$2,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,230.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,420.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,821.82
|
| Rate for Payer: Quartz Commercial |
$2,230.80
|
| Rate for Payer: WEA Trust Commercial |
$2,044.90
|
| Rate for Payer: WPS Commercial |
$2,753.92
|
|
|
Mometasone (Sinuva) 1350 mg Implant J7402
|
Professional
|
Both
|
$3,718.00
|
|
|
Service Code
|
HCPCS J7402
|
| Hospital Charge Code |
6174160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$3,532.10 |
| Rate for Payer: Aetna Commercial |
$3,532.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,197.48
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,532.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.34
|
| Rate for Payer: Health EOS Commercial |
$3,383.38
|
| Rate for Payer: HFN Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.18
|
| Rate for Payer: Multiplan Commercial |
$2,974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,532.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.92
|
| Rate for Payer: Quartz Commercial |
$2,119.26
|
| Rate for Payer: The Alliance Commercial |
$1,859.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.35
|
| Rate for Payer: WEA Trust Commercial |
$2,044.90
|
| Rate for Payer: WPS Commercial |
$28.36
|
|
|
Mometasone (Sinuva) 1350 mg Implant J7402
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
HCPCS J7402
|
| Hospital Charge Code |
6174160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$3,420.56 |
| Rate for Payer: Aetna Commercial |
$3,346.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,197.48
|
| Rate for Payer: Aetna Managed Medicare |
$11.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,416.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,859.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,784.64
|
| Rate for Payer: Anthem Medicare Advantage |
$11.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,970.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.34
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,420.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.34
|
| Rate for Payer: Health EOS Commercial |
$3,309.02
|
| Rate for Payer: HFN Commercial |
$3,420.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$2,974.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,420.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,821.82
|
| Rate for Payer: Quartz Commercial |
$2,416.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.34
|
| Rate for Payer: The Alliance Commercial |
$45.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.34
|
| Rate for Payer: WEA Trust Commercial |
$2,044.90
|
| Rate for Payer: Wellcare Medicare |
$11.34
|
| Rate for Payer: WPS Commercial |
$28.36
|
|
|
MONITORING KIT TRANSPAC IV 426500406
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2969719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
MONITORING KIT TRANSPAC IV 426500406
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2969719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
MONITOR QUICK PRESSURE SET 0295-002-000
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$5,400.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Aetna Managed Medicare |
$378.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$755.46
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,012.50
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$810.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$877.50
|
| Rate for Payer: Quartz Medicare Advantage |
$810.00
|
| Rate for Payer: The Alliance Commercial |
$5,400.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
MONITOR QUICK PRESSURE SET 0295-002-000
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2962901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$810.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$810.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.00
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$70.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$39.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.34
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$84.00
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Monoclonal Protein Study 24 Urine
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$100.70 |
| Rate for Payer: Aetna Commercial |
$100.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Anthem Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$100.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.60
|
| Rate for Payer: Health EOS Commercial |
$96.46
|
| Rate for Payer: HFN Commercial |
$100.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.94
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Preferred Network Access Commercial |
$100.70
|
| Rate for Payer: Quartz Beloit One Network |
$46.64
|
| Rate for Payer: Quartz Commercial |
$60.42
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Monoclonal Protein Study 24 Urine
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.60
|
| Rate for Payer: Anthem Medicaid |
$18.42
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Dean Health Medicaid |
$18.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Managed Health Services Medicaid |
$19.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.42
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$71.32
|
| Rate for Payer: United Healthcare Medicaid |
$18.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare PPO |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: Wellcare Medicare |
$17.83
|
| Rate for Payer: WMAP Medicaid |
$18.42
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Monoclonal Protein Study 24 Urine
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
Mononucleosis Screen
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Mononucleosis Screen
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$104.65
|
| Rate for Payer: HFN Commercial |
$109.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Preferred Network Access Commercial |
$109.25
|
| Rate for Payer: Quartz Beloit One Network |
$50.60
|
| Rate for Payer: Quartz Commercial |
$65.55
|
| Rate for Payer: The Alliance Commercial |
$57.50
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Mononucleosis Screen
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
633785
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$86.25
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Monovisc Inj 4ml J7327
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,442.56 |
| Max. Negotiated Rate |
$2,708.48 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,766.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,766.40
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
|
Monovisc Inj 4ml J7327
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$711.54 |
| Max. Negotiated Rate |
$2,796.80 |
| Rate for Payer: Aetna Commercial |
$2,796.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,796.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$711.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$711.54
|
| Rate for Payer: Health EOS Commercial |
$2,679.04
|
| Rate for Payer: HFN Commercial |
$2,796.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,035.21
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,796.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.36
|
| Rate for Payer: Quartz Commercial |
$1,678.08
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$711.54
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: WPS Commercial |
$1,778.86
|
|
|
Monovisc Inj 4ml J7327
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
HCPCS J7327
|
| Hospital Charge Code |
4634623
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$714.37 |
| Max. Negotiated Rate |
$2,857.47 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Aetna Managed Medicare |
$714.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,913.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.12
|
| Rate for Payer: Anthem Medicare Advantage |
$714.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$714.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$714.37
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$714.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$941.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$714.37
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,657.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$714.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$714.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$714.37
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,071.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,913.60
|
| Rate for Payer: Quartz Medicare Advantage |
$714.37
|
| Rate for Payer: The Alliance Commercial |
$2,857.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$714.37
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: Wellcare Medicare |
$714.37
|
| Rate for Payer: WPS Commercial |
$1,778.86
|
|
|
Monsel's Solution 1oz [Med]
|
Facility
|
OP
|
$67.00
|
|
| Hospital Charge Code |
2974900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Monsel's Solution 1oz [Med]
|
Facility
|
IP
|
$67.00
|
|
| Hospital Charge Code |
2974900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
MORCHER EYEJET 15A
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5459080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$7,680.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.20
|
| Rate for Payer: Aetna Managed Medicare |
$537.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,248.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$960.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,766.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.43
|
| Rate for Payer: Health EOS Commercial |
$1,708.80
|
| Rate for Payer: HFN Commercial |
$1,766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,440.00
|
| Rate for Payer: Multiplan Commercial |
$1,536.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.40
|
| Rate for Payer: Quartz Beloit One Network |
$940.80
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,152.00
|
| Rate for Payer: The Alliance Commercial |
$7,680.00
|
| Rate for Payer: WEA Trust Commercial |
$1,056.00
|
| Rate for Payer: WPS Commercial |
$1,422.14
|
|
