|
Prothrombin Time
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Prothrombin Time
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: United Healthcare PPO |
$83.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Prothrombin Time POC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
2580845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$32.60 |
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$32.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$31.23
|
| Rate for Payer: HFN Commercial |
$32.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$32.60
|
| Rate for Payer: Quartz Beloit One Network |
$15.10
|
| Rate for Payer: Quartz Commercial |
$19.56
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$19.63
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$10.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.33
|
| Rate for Payer: Anthem Medicare Advantage |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.20
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.20
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$15.30
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$141.28
|
| Rate for Payer: Quartz Medicare Advantage |
$10.20
|
| Rate for Payer: The Alliance Commercial |
$40.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.20
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: Wellcare Medicare |
$10.20
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.51 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
PROVISC 0004510128
|
Facility
|
IP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
PROVISC 0004510128
|
Facility
|
OP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.22 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$148.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$317.62
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$317.62
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$94.72 |
| Rate for Payer: Aetna Commercial |
$92.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.57
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$94.72
|
| Rate for Payer: Health EOS Commercial |
$91.63
|
| Rate for Payer: HFN Commercial |
$94.72
|
| Rate for Payer: Multiplan Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$94.72
|
| Rate for Payer: Quartz Beloit One Network |
$50.45
|
| Rate for Payer: Quartz Commercial |
$61.78
|
| Rate for Payer: WEA Trust Commercial |
$56.63
|
| Rate for Payer: WPS Commercial |
$76.26
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$94.72 |
| Rate for Payer: Aetna Commercial |
$92.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.55
|
| Rate for Payer: Aetna Managed Medicare |
$28.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.57
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$94.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.62
|
| Rate for Payer: Health EOS Commercial |
$91.63
|
| Rate for Payer: HFN Commercial |
$94.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.22
|
| Rate for Payer: Multiplan Commercial |
$82.37
|
| Rate for Payer: NAPHCARE Commercial |
$61.78
|
| Rate for Payer: Preferred Network Access Commercial |
$94.72
|
| Rate for Payer: Quartz Beloit One Network |
$50.45
|
| Rate for Payer: Quartz Commercial |
$66.92
|
| Rate for Payer: Quartz Medicare Advantage |
$61.78
|
| Rate for Payer: The Alliance Commercial |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$56.63
|
| Rate for Payer: WPS Commercial |
$76.26
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
OP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.53 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Aetna Managed Medicare |
$498.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.38
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,157.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.29
|
| Rate for Payer: The Alliance Commercial |
$890.24
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
IP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.44 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,068.29
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
PROVOX LIFE SHOWER 8308
|
Facility
|
OP
|
$721.00
|
|
| Hospital Charge Code |
6175031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$209.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.62
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.38
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$449.90
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$449.90
|
| Rate for Payer: The Alliance Commercial |
$374.92
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
PROVOX LIFE SHOWER 8308
|
Facility
|
IP
|
$721.00
|
|
| Hospital Charge Code |
6175031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$12,837.33 |
| Max. Negotiated Rate |
$24,102.75 |
| Rate for Payer: Aetna Commercial |
$23,578.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,530.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,885.28
|
| Rate for Payer: Cash Price |
$7,557.30
|
| Rate for Payer: Cigna Commercial |
$24,102.75
|
| Rate for Payer: Health EOS Commercial |
$23,316.79
|
| Rate for Payer: HFN Commercial |
$24,102.75
|
| Rate for Payer: Multiplan Commercial |
$20,958.91
|
| Rate for Payer: Preferred Network Access Commercial |
$24,102.75
|
| Rate for Payer: Quartz Beloit One Network |
$12,837.33
|
| Rate for Payer: Quartz Commercial |
$15,719.18
|
| Rate for Payer: WEA Trust Commercial |
$14,409.25
|
| Rate for Payer: WPS Commercial |
$19,404.63
|
|
|
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 |
$12,148.98 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$23,578.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,530.83
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,885.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| 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 |
$24,102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$23,316.79
|
| Rate for Payer: HFN Commercial |
$24,102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$20,958.91
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$24,102.75
|
| Rate for Payer: Quartz Beloit One Network |
$12,837.33
|
| Rate for Payer: Quartz Commercial |
$17,029.12
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$19,648.98
|
| Rate for Payer: WEA Trust Commercial |
$14,409.25
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$19,404.63
|
|
|
.PSA Free, Quest
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$75.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
.PSA Free, Quest
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
.PSA Free, Quest
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
3301541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: United Healthcare PPO |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
PSA only, No Rfx
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3457521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$75.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
