|
Prothrombin Time
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$101.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.20
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: HFN Commercial |
$101.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Preferred Network Access Commercial |
$101.65
|
| Rate for Payer: Quartz Beloit One Network |
$47.08
|
| Rate for Payer: Quartz Commercial |
$60.99
|
| Rate for Payer: The Alliance Commercial |
$53.50
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Prothrombin Time
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Prothrombin Time POC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
2580845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.80
|
| Rate for Payer: Health EOS Commercial |
$30.03
|
| Rate for Payer: HFN Commercial |
$31.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.35
|
| Rate for Payer: Quartz Beloit One Network |
$14.52
|
| Rate for Payer: Quartz Commercial |
$18.81
|
| Rate for Payer: The Alliance Commercial |
$16.50
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.32
|
| Rate for Payer: Anthem Medicare Advantage |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.95
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.95
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.92
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$135.85
|
| Rate for Payer: Quartz Medicare Advantage |
$7.95
|
| Rate for Payer: The Alliance Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: Wellcare Medicare |
$7.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
PROVISC 0004510128
|
Facility
|
OP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.52 |
| Max. Negotiated Rate |
$2,036.00 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$142.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.84
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.75
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$305.40
|
| Rate for Payer: The Alliance Commercial |
$2,036.00
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
PROVISC 0004510128
|
Facility
|
IP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.14
|
| Rate for Payer: Aetna Managed Medicare |
$27.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.47
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$91.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.40
|
| Rate for Payer: Health EOS Commercial |
$88.11
|
| Rate for Payer: HFN Commercial |
$91.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.25
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: NAPHCARE Commercial |
$59.40
|
| Rate for Payer: Preferred Network Access Commercial |
$91.08
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$64.35
|
| Rate for Payer: Quartz Medicare Advantage |
$59.40
|
| Rate for Payer: The Alliance Commercial |
$396.00
|
| Rate for Payer: WEA Trust Commercial |
$54.45
|
| Rate for Payer: WPS Commercial |
$73.33
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.47
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$91.08
|
| Rate for Payer: Health EOS Commercial |
$88.11
|
| Rate for Payer: HFN Commercial |
$91.08
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: NAPHCARE Commercial |
$59.40
|
| Rate for Payer: Preferred Network Access Commercial |
$91.08
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$59.40
|
| Rate for Payer: WEA Trust Commercial |
$54.45
|
| Rate for Payer: WPS Commercial |
$73.33
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
OP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.36 |
| Max. Negotiated Rate |
$6,848.00 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Aetna Managed Medicare |
$479.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,112.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.20
|
| Rate for Payer: The Alliance Commercial |
$6,848.00
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
IP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.88 |
| Max. Negotiated Rate |
$1,575.04 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,027.20
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
PROVOX LIFE SHOWER 8308
|
Facility
|
OP
|
$721.00
|
|
| Hospital Charge Code |
6175031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
PROVOX LIFE SHOWER 8308
|
Facility
|
IP
|
$721.00
|
|
| Hospital Charge Code |
6175031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
Prq Card Stent w/Angio 1 Vsl-Des
|
Facility
|
OP
|
$25,191.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
4964606
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10,873.62 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$22,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,664.26
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,311.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,676.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,643.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$7,557.30
|
| Rate for Payer: Cash Price |
$7,557.30
|
| Rate for Payer: Cash Price |
$7,557.30
|
| Rate for Payer: Cigna Commercial |
$23,175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$22,419.99
|
| Rate for Payer: HFN Commercial |
$23,175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$20,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$23,175.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,343.59
|
| Rate for Payer: Quartz Commercial |
$16,374.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$18,893.25
|
| Rate for Payer: WEA Trust Commercial |
$13,855.05
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$18,658.97
|
|
|
Prq Card Stent w/Angio 1 Vsl-Des
|
Facility
|
IP
|
$25,191.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
4964606
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,343.59 |
| Max. Negotiated Rate |
$23,175.72 |
| Rate for Payer: Aetna Commercial |
$22,671.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,664.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,351.23
|
| Rate for Payer: Cash Price |
$7,557.30
|
| Rate for Payer: Cigna Commercial |
$23,175.72
|
| Rate for Payer: Health EOS Commercial |
$22,419.99
|
| Rate for Payer: HFN Commercial |
$23,175.72
|
| Rate for Payer: Multiplan Commercial |
$20,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23,175.72
|
| Rate for Payer: Quartz Beloit One Network |
$12,343.59
|
| Rate for Payer: Quartz Commercial |
$15,114.60
|
| Rate for Payer: WEA Trust Commercial |
$13,855.05
|
| Rate for Payer: WPS Commercial |
$18,658.97
|
|
|
.PSA Free, Quest
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
.PSA Free, Quest
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$73.56 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.53
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.39
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.39
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.39
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.58
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$18.39
|
| Rate for Payer: The Alliance Commercial |
$73.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$18.39
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
.PSA Free, Quest
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$64.92 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.92
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
PSA only, No Rfx
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3457521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$18.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.53
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.39
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.68
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.39
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.39
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.58
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18.39
|
| Rate for Payer: The Alliance Commercial |
$73.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare PPO |
$228.75
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$18.39
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
