|
MOHS MICROGRAPHIC SURGERY
|
Facility
|
OP
|
$884.45
|
|
|
Service Code
|
EAPG 00019
|
| Min. Negotiated Rate |
$850.43 |
| Max. Negotiated Rate |
$884.45 |
| Rate for Payer: Anthem Medicaid |
$850.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$850.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$850.43
|
| Rate for Payer: Dean Health Medicaid |
$850.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$850.43
|
| Rate for Payer: Managed Health Services Medicaid |
$884.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$850.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$850.43
|
| Rate for Payer: United Healthcare Medicaid |
$850.43
|
|
|
Molded inner boot L2280
|
Facility
|
IP
|
$1,581.00
|
|
|
Service Code
|
HCPCS L2280
|
| Hospital Charge Code |
4524749
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$805.68 |
| Max. Negotiated Rate |
$1,512.70 |
| Rate for Payer: Aetna Commercial |
$1,479.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.45
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,512.70
|
| Rate for Payer: Health EOS Commercial |
$1,463.37
|
| Rate for Payer: HFN Commercial |
$1,512.70
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.70
|
| Rate for Payer: Quartz Beloit One Network |
$805.68
|
| Rate for Payer: Quartz Commercial |
$986.54
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$1,217.84
|
|
|
Molded inner boot L2280
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS L2280
|
| Hospital Charge Code |
4524749
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$721.53 |
| Max. Negotiated Rate |
$2,080.44 |
| Rate for Payer: Aetna Commercial |
$1,562.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Aetna Managed Medicare |
$721.53
|
| Rate for Payer: Anthem Medicare Advantage |
$721.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$721.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$721.53
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,562.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$822.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$721.53
|
| Rate for Payer: Health EOS Commercial |
$1,496.26
|
| Rate for Payer: HFN Commercial |
$1,562.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,080.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,080.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$721.53
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,082.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.03
|
| Rate for Payer: Quartz Beloit One Network |
$723.47
|
| Rate for Payer: Quartz Commercial |
$937.22
|
| Rate for Payer: Quartz Medicare Advantage |
$721.53
|
| Rate for Payer: The Alliance Commercial |
$1,984.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$721.53
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$1,262.68
|
|
|
Molded inner boot L2280
|
Facility
|
OP
|
$1,581.00
|
|
|
Service Code
|
HCPCS L2280
|
| Hospital Charge Code |
4524749
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$328.98 |
| Max. Negotiated Rate |
$2,886.12 |
| Rate for Payer: Aetna Commercial |
$1,479.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Aetna Managed Medicare |
$460.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$328.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.45
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,512.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$920.14
|
| Rate for Payer: Health EOS Commercial |
$1,463.37
|
| Rate for Payer: HFN Commercial |
$1,512.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,233.18
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: NAPHCARE Commercial |
$986.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.70
|
| Rate for Payer: Quartz Beloit One Network |
$805.68
|
| Rate for Payer: Quartz Commercial |
$1,068.76
|
| Rate for Payer: Quartz Medicare Advantage |
$986.54
|
| Rate for Payer: The Alliance Commercial |
$2,886.12
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$1,217.84
|
|
|
Molecular Iso, Highly Purified
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Molecular Iso, Highly Purified
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Molecular Iso, Highly Purified
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Molecular Nucleic Amp 2 Seq
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2776838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Molecular Nucleic Amp 2 Seq
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2776838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Molecular Nucleic Amp 2 Seq
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2776838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Molecule Nucleic Amp IgVh
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
Molecule Nucleic Amp IgVh
|
Professional
|
Both
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.01 |
| Max. Negotiated Rate |
$151.16 |
| Rate for Payer: Aetna Commercial |
$151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$151.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.47
|
| Rate for Payer: Health EOS Commercial |
$144.80
|
| Rate for Payer: HFN Commercial |
$151.16
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$151.16
|
| Rate for Payer: Quartz Beloit One Network |
$70.01
|
| Rate for Payer: Quartz Commercial |
$90.70
|
| Rate for Payer: The Alliance Commercial |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
Molecule Nucleic Amp IgVh
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
2776839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.05
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.34
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$95.47
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$95.47
|
| Rate for Payer: The Alliance Commercial |
$79.56
|
| Rate for Payer: United Healthcare PPO |
$119.34
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
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 |
$11.80 |
| Max. Negotiated Rate |
$3,673.38 |
| Rate for Payer: Aetna Commercial |
$3,673.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,325.38
|
| Rate for Payer: Aetna Managed Medicare |
$11.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.80
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,673.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.80
|
| Rate for Payer: Health EOS Commercial |
$3,518.72
|
| Rate for Payer: HFN Commercial |
$3,673.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$3,093.38
|
| Rate for Payer: NAPHCARE Commercial |
$17.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,673.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.36
|
| Rate for Payer: Quartz Commercial |
$2,204.03
|
| Rate for Payer: Quartz Medicare Advantage |
$11.80
|
| Rate for Payer: The Alliance Commercial |
$32.46
|
| Rate for Payer: United Healthcare Medicaid |
$11.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.80
|
| Rate for Payer: WEA Trust Commercial |
$2,126.70
|
| Rate for Payer: WPS Commercial |
$29.50
|
|
|
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 |
$1,894.69 |
| Max. Negotiated Rate |
$3,557.38 |
| Rate for Payer: Aetna Commercial |
$3,480.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,325.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.36
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,557.38
|
| Rate for Payer: Health EOS Commercial |
$3,441.38
|
| Rate for Payer: HFN Commercial |
$3,557.38
|
| Rate for Payer: Multiplan Commercial |
$3,093.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,557.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,894.69
|
| Rate for Payer: Quartz Commercial |
$2,320.03
|
| Rate for Payer: WEA Trust Commercial |
$2,126.70
|
| Rate for Payer: WPS Commercial |
$2,863.98
|
|
|
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 |
$11.80 |
| Max. Negotiated Rate |
$3,557.38 |
| Rate for Payer: Aetna Commercial |
$3,480.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,325.38
|
| Rate for Payer: Aetna Managed Medicare |
$11.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,513.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,933.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,856.03
|
| Rate for Payer: Anthem Medicare Advantage |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.80
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cash Price |
$1,115.40
|
| Rate for Payer: Cigna Commercial |
$3,557.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.80
|
| Rate for Payer: Health EOS Commercial |
$3,441.38
|
| Rate for Payer: HFN Commercial |
$3,557.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$3,093.38
|
| Rate for Payer: NAPHCARE Commercial |
$17.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,557.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,894.69
|
| Rate for Payer: Quartz Commercial |
$2,513.37
|
| Rate for Payer: Quartz Medicare Advantage |
$11.80
|
| Rate for Payer: The Alliance Commercial |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.80
|
| Rate for Payer: WEA Trust Commercial |
$2,126.70
|
| Rate for Payer: Wellcare Medicare |
$11.80
|
| Rate for Payer: WPS Commercial |
$29.50
|
|
|
MONITORING KIT TRANSPAC IV 426500406
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
2969719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
MONITORING KIT TRANSPAC IV 426500406
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
2969719
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
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 |
$393.12 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$393.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$912.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$702.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$673.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.70
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.00
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$912.60
|
| Rate for Payer: Quartz Medicare Advantage |
$842.40
|
| Rate for Payer: The Alliance Commercial |
$702.00
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
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 |
$687.96 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$213.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: United Healthcare PPO |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: Wellcare Medicare |
$53.36
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Monkeypox Virus DNA, Qual PCR
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
6167928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$234.79 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$210.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$234.79
|
|
|
Monoclonal Protein Study 24 Urine
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$18.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.54
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.54
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.54
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$27.81
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$18.54
|
| Rate for Payer: The Alliance Commercial |
$74.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.54
|
| Rate for Payer: United Healthcare PPO |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: Wellcare Medicare |
$18.54
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Monoclonal Protein Study 24 Urine
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
4630631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$104.73 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$18.54
|
| Rate for Payer: Anthem Commercial |
$20.19
|
| Rate for Payer: Anthem Medicare Advantage |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.54
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$104.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.54
|
| Rate for Payer: Health EOS Commercial |
$100.32
|
| Rate for Payer: HFN Commercial |
$104.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.54
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$27.81
|
| Rate for Payer: Preferred Network Access Commercial |
$104.73
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$62.84
|
| Rate for Payer: Quartz Medicare Advantage |
$18.54
|
| Rate for Payer: The Alliance Commercial |
$73.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.54
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.59
|
|
