|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$21,554.00
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,499.65 |
| Max. Negotiated Rate |
$21,554.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,499.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,464.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,620.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,989.93
|
| Rate for Payer: Anthem Medicare Advantage |
$6,499.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,499.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,499.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,499.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,309.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,499.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,564.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,499.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,499.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,499.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,499.65
|
| Rate for Payer: NAPHCARE Commercial |
$9,749.47
|
| Rate for Payer: Quartz Medicare Advantage |
$6,499.65
|
| Rate for Payer: The Alliance Commercial |
$21,554.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,499.65
|
| Rate for Payer: United Healthcare PPO |
$12,117.48
|
| Rate for Payer: Wellcare Medicare |
$6,499.65
|
|
|
PATHOLOGY CONSULTATION AND INTERPRETATION
|
Facility
|
OP
|
$48.48
|
|
|
Service Code
|
EAPG 00158
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$48.48 |
| Rate for Payer: Anthem Medicaid |
$46.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$46.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.62
|
| Rate for Payer: Dean Health Medicaid |
$46.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46.62
|
| Rate for Payer: Managed Health Services Medicaid |
$48.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46.62
|
| Rate for Payer: United Healthcare Medicaid |
$46.62
|
|
|
PATHWAY TRAINER TR-20 #2933-01
|
Facility
|
IP
|
$6,018.00
|
|
| Hospital Charge Code |
2973682
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,066.77 |
| Max. Negotiated Rate |
$5,758.02 |
| Rate for Payer: Aetna Commercial |
$5,632.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,382.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,317.12
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cigna Commercial |
$5,758.02
|
| Rate for Payer: Health EOS Commercial |
$5,570.26
|
| Rate for Payer: HFN Commercial |
$5,758.02
|
| Rate for Payer: Multiplan Commercial |
$5,006.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,758.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,066.77
|
| Rate for Payer: Quartz Commercial |
$3,755.23
|
| Rate for Payer: WEA Trust Commercial |
$3,442.30
|
| Rate for Payer: WPS Commercial |
$4,635.67
|
|
|
PATHWAY TRAINER TR-20 #2933-01
|
Facility
|
OP
|
$6,018.00
|
|
| Hospital Charge Code |
2973682
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,752.44 |
| Max. Negotiated Rate |
$5,758.02 |
| Rate for Payer: Aetna Commercial |
$5,632.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,382.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,752.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,068.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,129.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,004.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,317.12
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cigna Commercial |
$5,758.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,502.48
|
| Rate for Payer: Health EOS Commercial |
$5,570.26
|
| Rate for Payer: HFN Commercial |
$5,758.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,694.04
|
| Rate for Payer: Multiplan Commercial |
$5,006.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,755.23
|
| Rate for Payer: Preferred Network Access Commercial |
$5,758.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,066.77
|
| Rate for Payer: Quartz Commercial |
$4,068.17
|
| Rate for Payer: Quartz Medicare Advantage |
$3,755.23
|
| Rate for Payer: The Alliance Commercial |
$3,129.36
|
| Rate for Payer: WEA Trust Commercial |
$3,442.30
|
| Rate for Payer: WPS Commercial |
$4,635.67
|
|
|
PATIENT KIT GENTLE TOUCH II SPINAL TOP DISP MIZUHO 5808
|
Facility
|
OP
|
$427.76
|
|
| Hospital Charge Code |
6244185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.56 |
| Max. Negotiated Rate |
$409.28 |
| Rate for Payer: Aetna Commercial |
$400.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.59
|
| Rate for Payer: Aetna Managed Medicare |
$124.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$289.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.78
|
| Rate for Payer: Cash Price |
$128.33
|
| Rate for Payer: Cigna Commercial |
$409.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.96
|
| Rate for Payer: Health EOS Commercial |
$395.93
|
| Rate for Payer: HFN Commercial |
$409.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.65
|
| Rate for Payer: Multiplan Commercial |
$355.90
|
| Rate for Payer: NAPHCARE Commercial |
$266.92
|
| Rate for Payer: Preferred Network Access Commercial |
$409.28
|
| Rate for Payer: Quartz Beloit One Network |
$217.99
|
| Rate for Payer: Quartz Commercial |
$289.17
|
| Rate for Payer: Quartz Medicare Advantage |
$266.92
|
| Rate for Payer: The Alliance Commercial |
$222.44
|
| Rate for Payer: WEA Trust Commercial |
$244.68
|
| Rate for Payer: WPS Commercial |
$329.50
|
|
|
PATIENT KIT GENTLE TOUCH II SPINAL TOP DISP MIZUHO 5808
|
Facility
|
IP
|
$427.76
|
|
| Hospital Charge Code |
6244185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.99 |
| Max. Negotiated Rate |
$409.28 |
| Rate for Payer: Aetna Commercial |
$400.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.78
|
| Rate for Payer: Cash Price |
$128.33
|
| Rate for Payer: Cigna Commercial |
$409.28
|
| Rate for Payer: Health EOS Commercial |
$395.93
|
| Rate for Payer: HFN Commercial |
$409.28
|
| Rate for Payer: Multiplan Commercial |
$355.90
|
| Rate for Payer: Preferred Network Access Commercial |
$409.28
|
| Rate for Payer: Quartz Beloit One Network |
$217.99
|
| Rate for Payer: Quartz Commercial |
$266.92
|
| Rate for Payer: WEA Trust Commercial |
$244.68
|
| Rate for Payer: WPS Commercial |
$329.50
|
|
|
PBP2' Test
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
1562808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$52.81
|
|
|
PBP2' Test
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
1562808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
PBP2' Test
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
1562808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
PCA PUMP
|
Facility
|
IP
|
$565.00
|
|
| Hospital Charge Code |
3075869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
PCA PUMP
|
Facility
|
OP
|
$565.00
|
|
| Hospital Charge Code |
3075869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$164.53 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$164.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.83
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.70
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$352.56
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$352.56
|
| Rate for Payer: The Alliance Commercial |
$293.80
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
PCA Pump - Devices and Equipment
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
3002377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
PCA Pump - Devices and Equipment
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
3002377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$282.36
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
PCA SET TUBING Y-CONNECTOR DEHP-FREE 3ML 10800175
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
4089811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.88
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$91.10
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.10
|
| Rate for Payer: The Alliance Commercial |
$75.92
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
PCA SET TUBING Y-CONNECTOR DEHP-FREE 3ML 10800175
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
4089811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
PCP Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
PCP Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
PCP Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
PCR DNA Marker 3020insC
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.10
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.63
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$96.10
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$104.10
|
| Rate for Payer: Quartz Medicare Advantage |
$96.10
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: United Healthcare PPO |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$96.10
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker C2104T
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.63
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$96.10
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$104.10
|
| Rate for Payer: Quartz Medicare Advantage |
$96.10
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: United Healthcare PPO |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker C2104T
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$96.10
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker C2104T
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.10
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PCR DNA Marker G2722C
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.10
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
