|
ANTERIOR CRUCIATE LIG W/BONE TENDON BONE
|
Facility
|
OP
|
$8,979.00
|
|
| Hospital Charge Code |
2959777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,614.68 |
| Max. Negotiated Rate |
$8,591.11 |
| Rate for Payer: Aetna Commercial |
$8,404.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,030.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,614.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,069.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,669.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,482.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.22
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,591.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,225.78
|
| Rate for Payer: Health EOS Commercial |
$8,310.96
|
| Rate for Payer: HFN Commercial |
$8,591.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,003.62
|
| Rate for Payer: Multiplan Commercial |
$7,470.53
|
| Rate for Payer: NAPHCARE Commercial |
$5,602.90
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,575.70
|
| Rate for Payer: Quartz Commercial |
$6,069.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,602.90
|
| Rate for Payer: The Alliance Commercial |
$4,669.08
|
| Rate for Payer: WEA Trust Commercial |
$5,135.99
|
| Rate for Payer: WPS Commercial |
$6,916.52
|
|
|
ANTERIOR CRUCIATE LIG W/BONE TENDON BONE
|
Facility
|
IP
|
$8,979.00
|
|
| Hospital Charge Code |
2959777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,575.70 |
| Max. Negotiated Rate |
$8,591.11 |
| Rate for Payer: Aetna Commercial |
$8,404.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,030.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.22
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,591.11
|
| Rate for Payer: Health EOS Commercial |
$8,310.96
|
| Rate for Payer: HFN Commercial |
$8,591.11
|
| Rate for Payer: Multiplan Commercial |
$7,470.53
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,575.70
|
| Rate for Payer: Quartz Commercial |
$5,602.90
|
| Rate for Payer: WEA Trust Commercial |
$5,135.99
|
| Rate for Payer: WPS Commercial |
$6,916.52
|
|
|
ANTERIOR POSTERIOR/RECTOCELE REPAIR
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ANTERIOR POSTERIOR/RECTOCELE REPAIR
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,807.99 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
AntibioticPocket ICD
|
Professional
|
Both
|
$7,927.00
|
|
| Hospital Charge Code |
2549042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,627.40 |
| Max. Negotiated Rate |
$7,831.88 |
| Rate for Payer: Aetna Commercial |
$7,831.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,089.91
|
| Rate for Payer: Cash Price |
$2,378.10
|
| Rate for Payer: Cigna Commercial |
$7,831.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,122.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,946.45
|
| Rate for Payer: Health EOS Commercial |
$7,502.11
|
| Rate for Payer: HFN Commercial |
$7,831.88
|
| Rate for Payer: Multiplan Commercial |
$6,595.26
|
| Rate for Payer: Preferred Network Access Commercial |
$7,831.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,627.40
|
| Rate for Payer: Quartz Commercial |
$4,699.13
|
| Rate for Payer: The Alliance Commercial |
$4,122.04
|
| Rate for Payer: WEA Trust Commercial |
$4,534.24
|
| Rate for Payer: WPS Commercial |
$6,106.17
|
|
|
AntibioticPocket ICD
|
Facility
|
OP
|
$7,927.00
|
|
| Hospital Charge Code |
2549042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,308.34 |
| Max. Negotiated Rate |
$7,584.55 |
| Rate for Payer: Aetna Commercial |
$7,419.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,089.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,308.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,358.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,122.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,957.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,369.36
|
| Rate for Payer: Cash Price |
$2,378.10
|
| Rate for Payer: Cigna Commercial |
$7,584.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,613.51
|
| Rate for Payer: Health EOS Commercial |
$7,337.23
|
| Rate for Payer: HFN Commercial |
$7,584.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,183.06
|
| Rate for Payer: Multiplan Commercial |
$6,595.26
|
| Rate for Payer: NAPHCARE Commercial |
$4,946.45
|
| Rate for Payer: Preferred Network Access Commercial |
$7,584.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,039.60
|
| Rate for Payer: Quartz Commercial |
$5,358.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,946.45
|
| Rate for Payer: The Alliance Commercial |
$4,122.04
|
| Rate for Payer: WEA Trust Commercial |
$4,534.24
|
| Rate for Payer: WPS Commercial |
$6,106.17
|
|
|
AntibioticPocket ICD
|
Facility
|
IP
|
$7,927.00
|
|
| Hospital Charge Code |
2549042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,039.60 |
| Max. Negotiated Rate |
$7,584.55 |
| Rate for Payer: Aetna Commercial |
$7,419.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,089.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,369.36
|
| Rate for Payer: Cash Price |
$2,378.10
|
| Rate for Payer: Cigna Commercial |
$7,584.55
|
| Rate for Payer: Health EOS Commercial |
$7,337.23
|
| Rate for Payer: HFN Commercial |
$7,584.55
|
| Rate for Payer: Multiplan Commercial |
$6,595.26
|
| Rate for Payer: Preferred Network Access Commercial |
$7,584.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,039.60
|
| Rate for Payer: Quartz Commercial |
$4,946.45
|
| Rate for Payer: WEA Trust Commercial |
$4,534.24
|
| Rate for Payer: WPS Commercial |
$6,106.17
|
|
|
AntibioticPocket Pacemaker
|
Professional
|
Both
|
$43,831.00
|
|
| Hospital Charge Code |
2549044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,057.07 |
| Max. Negotiated Rate |
$43,305.03 |
| Rate for Payer: Aetna Commercial |
$43,305.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,202.45
|
| Rate for Payer: Cash Price |
$13,149.30
|
| Rate for Payer: Cigna Commercial |
$43,305.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,792.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,350.54
|
| Rate for Payer: Health EOS Commercial |
$41,481.66
|
| Rate for Payer: HFN Commercial |
$43,305.03
|
| Rate for Payer: Multiplan Commercial |
$36,467.39
|
| Rate for Payer: Preferred Network Access Commercial |
$43,305.03
|
| Rate for Payer: Quartz Beloit One Network |
$20,057.07
|
| Rate for Payer: Quartz Commercial |
$25,983.02
|
| Rate for Payer: The Alliance Commercial |
$22,792.12
|
| Rate for Payer: WEA Trust Commercial |
$25,071.33
|
| Rate for Payer: WPS Commercial |
$33,763.02
|
|
|
AntibioticPocket Pacemaker
|
Facility
|
OP
|
$43,831.00
|
|
| Hospital Charge Code |
2549044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,763.59 |
| Max. Negotiated Rate |
$41,937.50 |
| Rate for Payer: Aetna Commercial |
$41,025.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,202.45
|
| Rate for Payer: Aetna Managed Medicare |
$12,763.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,629.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,792.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,880.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,159.65
|
| Rate for Payer: Cash Price |
$13,149.30
|
| Rate for Payer: Cigna Commercial |
$41,937.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,509.64
|
| Rate for Payer: Health EOS Commercial |
$40,569.97
|
| Rate for Payer: HFN Commercial |
$41,937.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,188.18
|
| Rate for Payer: Multiplan Commercial |
$36,467.39
|
| Rate for Payer: NAPHCARE Commercial |
$27,350.54
|
| Rate for Payer: Preferred Network Access Commercial |
$41,937.50
|
| Rate for Payer: Quartz Beloit One Network |
$22,336.28
|
| Rate for Payer: Quartz Commercial |
$29,629.76
|
| Rate for Payer: Quartz Medicare Advantage |
$27,350.54
|
| Rate for Payer: The Alliance Commercial |
$22,792.12
|
| Rate for Payer: WEA Trust Commercial |
$25,071.33
|
| Rate for Payer: WPS Commercial |
$33,763.02
|
|
|
AntibioticPocket Pacemaker
|
Facility
|
IP
|
$43,831.00
|
|
| Hospital Charge Code |
2549044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,336.28 |
| Max. Negotiated Rate |
$41,937.50 |
| Rate for Payer: Aetna Commercial |
$41,025.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,202.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,159.65
|
| Rate for Payer: Cash Price |
$13,149.30
|
| Rate for Payer: Cigna Commercial |
$41,937.50
|
| Rate for Payer: Health EOS Commercial |
$40,569.97
|
| Rate for Payer: HFN Commercial |
$41,937.50
|
| Rate for Payer: Multiplan Commercial |
$36,467.39
|
| Rate for Payer: Preferred Network Access Commercial |
$41,937.50
|
| Rate for Payer: Quartz Beloit One Network |
$22,336.28
|
| Rate for Payer: Quartz Commercial |
$27,350.54
|
| Rate for Payer: WEA Trust Commercial |
$25,071.33
|
| Rate for Payer: WPS Commercial |
$33,763.02
|
|
|
Antibody ID Panel
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2955461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| 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: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| 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: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$302.85
|
| 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: United Healthcare PPO |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
Antibody ID Panel
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2955461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Aetna Commercial |
$419.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.94
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$428.65
|
| Rate for Payer: Health EOS Commercial |
$414.67
|
| Rate for Payer: HFN Commercial |
$428.65
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: Preferred Network Access Commercial |
$428.65
|
| Rate for Payer: Quartz Beloit One Network |
$228.30
|
| Rate for Payer: Quartz Commercial |
$279.55
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
Antibody ID Panel
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2955461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.45 |
| Max. Negotiated Rate |
$442.62 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$442.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.55
|
| Rate for Payer: Health EOS Commercial |
$423.99
|
| Rate for Payer: HFN Commercial |
$442.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.45
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: Preferred Network Access Commercial |
$442.62
|
| Rate for Payer: Quartz Beloit One Network |
$205.00
|
| Rate for Payer: Quartz Commercial |
$265.57
|
| Rate for Payer: The Alliance Commercial |
$232.96
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$345.09
|
|
|
Antibody Screen
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
973764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$10.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.16
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.16
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$15.24
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$148.72
|
| Rate for Payer: Quartz Medicare Advantage |
$10.16
|
| Rate for Payer: The Alliance Commercial |
$40.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.16
|
| Rate for Payer: United Healthcare PPO |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: Wellcare Medicare |
$10.16
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
Antibody Screen
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
973764
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
Anti-C Bir1
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Anti-C Bir1
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$71.84 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Anti-C Bir1
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti Endomysial IgA
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2770807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$408.55 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$266.45
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
Anti Endomysial IgA
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2770807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$421.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$421.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$404.11
|
| Rate for Payer: HFN Commercial |
$421.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$421.88
|
| Rate for Payer: Quartz Beloit One Network |
$195.40
|
| Rate for Payer: Quartz Commercial |
$253.13
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
Anti Endomysial IgA
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2770807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$333.06
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
Anti-Enterocyte Antibodies
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
5150631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$1,034.44 |
| Rate for Payer: Aetna Commercial |
$1,034.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,034.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$544.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$990.88
|
| Rate for Payer: HFN Commercial |
$1,034.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.44
|
| Rate for Payer: Quartz Beloit One Network |
$479.11
|
| Rate for Payer: Quartz Commercial |
$620.66
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
Anti-Enterocyte Antibodies
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
5150631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$533.55 |
| Max. Negotiated Rate |
$1,001.77 |
| Rate for Payer: Aetna Commercial |
$979.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.11
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,001.77
|
| Rate for Payer: Health EOS Commercial |
$969.10
|
| Rate for Payer: HFN Commercial |
$1,001.77
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.77
|
| Rate for Payer: Quartz Beloit One Network |
$533.55
|
| Rate for Payer: Quartz Commercial |
$653.33
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: WPS Commercial |
$806.50
|
|
|
Anti-Enterocyte Antibodies
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
5150631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$1,001.77 |
| Rate for Payer: Aetna Commercial |
$979.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$707.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$522.66
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,001.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$609.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$969.10
|
| Rate for Payer: HFN Commercial |
$1,001.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.77
|
| Rate for Payer: Quartz Beloit One Network |
$533.55
|
| Rate for Payer: Quartz Commercial |
$707.77
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$806.50
|
|
