|
Rabies Vaccine Titer
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$17.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.19
|
| Rate for Payer: Anthem Medicare Advantage |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.59
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.59
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.59
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$26.38
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$17.59
|
| Rate for Payer: The Alliance Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.59
|
| Rate for Payer: United Healthcare PPO |
$113.10
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: Wellcare Medicare |
$17.59
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Rabies Vaccine Titer
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$17.59
|
| Rate for Payer: Anthem Medicare Advantage |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.59
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$143.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.59
|
| Rate for Payer: Health EOS Commercial |
$137.23
|
| Rate for Payer: HFN Commercial |
$143.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.59
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$26.38
|
| Rate for Payer: Preferred Network Access Commercial |
$143.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.35
|
| Rate for Payer: Quartz Commercial |
$85.96
|
| Rate for Payer: Quartz Medicare Advantage |
$17.59
|
| Rate for Payer: The Alliance Commercial |
$69.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.59
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$77.38
|
|
|
Rabies Vaccine Titer
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
3259497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Rad Dosimetry Calculation Plan 7730026
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 77300 26
|
| Hospital Charge Code |
5258628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.81 |
| Max. Negotiated Rate |
$320.11 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$32.81
|
| Rate for Payer: Anthem Medicare Advantage |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.81
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$320.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.81
|
| Rate for Payer: Health EOS Commercial |
$306.63
|
| Rate for Payer: HFN Commercial |
$320.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.81
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$49.22
|
| Rate for Payer: Preferred Network Access Commercial |
$320.11
|
| Rate for Payer: Quartz Beloit One Network |
$148.26
|
| Rate for Payer: Quartz Commercial |
$192.07
|
| Rate for Payer: Quartz Medicare Advantage |
$32.81
|
| Rate for Payer: The Alliance Commercial |
$124.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.81
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$164.06
|
|
|
Radex Ribs Uni W/Posteroant 71101
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
4538771
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$41.30
|
| Rate for Payer: Anthem Medicare Advantage |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.30
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.30
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$61.95
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$41.30
|
| Rate for Payer: The Alliance Commercial |
$156.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.30
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$206.49
|
|
|
Radex Ribs Uni W/Posteroant 7110126
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 71101 26
|
| Hospital Charge Code |
4538772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$47.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$62.87
|
|
|
RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS 72120-26
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 72120 26
|
| Hospital Charge Code |
6219419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$53.66
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM LT 5001-0520L-S
|
Facility
|
IP
|
$29,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6210960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,963.89 |
| Max. Negotiated Rate |
$28,095.48 |
| Rate for Payer: Aetna Commercial |
$27,484.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26,263.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,185.44
|
| Rate for Payer: Cash Price |
$8,809.20
|
| Rate for Payer: Cigna Commercial |
$28,095.48
|
| Rate for Payer: Health EOS Commercial |
$27,179.32
|
| Rate for Payer: HFN Commercial |
$28,095.48
|
| Rate for Payer: Multiplan Commercial |
$24,430.85
|
| Rate for Payer: Preferred Network Access Commercial |
$28,095.48
|
| Rate for Payer: Quartz Beloit One Network |
$14,963.89
|
| Rate for Payer: Quartz Commercial |
$18,323.14
|
| Rate for Payer: WEA Trust Commercial |
$16,796.21
|
| Rate for Payer: WPS Commercial |
$22,619.09
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM LT 5001-0520L-S
|
Facility
|
OP
|
$29,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6210960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,550.80 |
| Max. Negotiated Rate |
$28,095.48 |
| Rate for Payer: Aetna Commercial |
$27,484.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26,263.16
|
| Rate for Payer: Aetna Managed Medicare |
$8,550.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,850.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,269.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,658.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16,185.44
|
| Rate for Payer: Cash Price |
$8,809.20
|
| Rate for Payer: Cigna Commercial |
$28,095.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,089.85
|
| Rate for Payer: Health EOS Commercial |
$27,179.32
|
| Rate for Payer: HFN Commercial |
$28,095.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,903.92
|
| Rate for Payer: Multiplan Commercial |
$24,430.85
|
| Rate for Payer: NAPHCARE Commercial |
$18,323.14
|
| Rate for Payer: Preferred Network Access Commercial |
$28,095.48
|
| Rate for Payer: Quartz Beloit One Network |
$14,963.89
|
| Rate for Payer: Quartz Commercial |
$19,850.06
|
| Rate for Payer: Quartz Medicare Advantage |
$18,323.14
|
| Rate for Payer: The Alliance Commercial |
$15,269.28
|
| Rate for Payer: WEA Trust Commercial |
$16,796.21
|
| Rate for Payer: WPS Commercial |
$22,619.09
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM RT 5001-0520R-S
|
Facility
|
IP
|
$24,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,546.86 |
| Max. Negotiated Rate |
$23,557.37 |
| Rate for Payer: Aetna Commercial |
$23,045.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,021.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,571.10
|
| Rate for Payer: Cash Price |
$7,386.30
|
| Rate for Payer: Cigna Commercial |
$23,557.37
|
| Rate for Payer: Health EOS Commercial |
$22,789.20
|
| Rate for Payer: HFN Commercial |
$23,557.37
|
| Rate for Payer: Multiplan Commercial |
$20,484.67
|
| Rate for Payer: Preferred Network Access Commercial |
$23,557.37
|
| Rate for Payer: Quartz Beloit One Network |
$12,546.86
|
| Rate for Payer: Quartz Commercial |
$15,363.50
|
| Rate for Payer: WEA Trust Commercial |
$14,083.21
|
| Rate for Payer: WPS Commercial |
$18,965.56
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM RT 5001-0520R-S
|
Facility
|
OP
|
$24,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,169.64 |
| Max. Negotiated Rate |
$23,557.37 |
| Rate for Payer: Aetna Commercial |
$23,045.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,021.02
|
| Rate for Payer: Aetna Managed Medicare |
$7,169.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,643.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,802.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,290.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,571.10
|
| Rate for Payer: Cash Price |
$7,386.30
|
| Rate for Payer: Cigna Commercial |
$23,557.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,329.42
|
| Rate for Payer: Health EOS Commercial |
$22,789.20
|
| Rate for Payer: HFN Commercial |
$23,557.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,204.38
|
| Rate for Payer: Multiplan Commercial |
$20,484.67
|
| Rate for Payer: NAPHCARE Commercial |
$15,363.50
|
| Rate for Payer: Preferred Network Access Commercial |
$23,557.37
|
| Rate for Payer: Quartz Beloit One Network |
$12,546.86
|
| Rate for Payer: Quartz Commercial |
$16,643.80
|
| Rate for Payer: Quartz Medicare Advantage |
$15,363.50
|
| Rate for Payer: The Alliance Commercial |
$12,802.92
|
| Rate for Payer: WEA Trust Commercial |
$14,083.21
|
| Rate for Payer: WPS Commercial |
$18,965.56
|
|
|
RADIAL JAW 4 ENDO BIOPSY W/O NEEDLE M00513380
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
5563607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
RADIAL JAW 4 ENDO BIOPSY W/O NEEDLE M00513380
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
5563607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$91.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
RADIAL JAW COLON BIOPSY M00513332
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2973547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
RADIAL JAW COLON BIOPSY M00513332
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2973547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
RADIAL STEM ACUMED 9.0 X 2.0MM TR-S0902-S
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.32 |
| Max. Negotiated Rate |
$1,328.04 |
| Rate for Payer: Aetna Commercial |
$1,299.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$765.07
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,328.04
|
| Rate for Payer: Health EOS Commercial |
$1,284.73
|
| Rate for Payer: HFN Commercial |
$1,328.04
|
| Rate for Payer: Multiplan Commercial |
$1,154.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,328.04
|
| Rate for Payer: Quartz Beloit One Network |
$707.32
|
| Rate for Payer: Quartz Commercial |
$866.11
|
| Rate for Payer: WEA Trust Commercial |
$793.94
|
| Rate for Payer: WPS Commercial |
$1,069.18
|
|
|
RADIAL STEM ACUMED 9.0 X 2.0MM TR-S0902-S
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.19 |
| Max. Negotiated Rate |
$1,328.04 |
| Rate for Payer: Aetna Commercial |
$1,299.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.43
|
| Rate for Payer: Aetna Managed Medicare |
$404.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$938.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$721.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$692.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$765.07
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,328.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$807.82
|
| Rate for Payer: Health EOS Commercial |
$1,284.73
|
| Rate for Payer: HFN Commercial |
$1,328.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,082.64
|
| Rate for Payer: Multiplan Commercial |
$1,154.82
|
| Rate for Payer: NAPHCARE Commercial |
$866.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,328.04
|
| Rate for Payer: Quartz Beloit One Network |
$707.32
|
| Rate for Payer: Quartz Commercial |
$938.29
|
| Rate for Payer: Quartz Medicare Advantage |
$866.11
|
| Rate for Payer: The Alliance Commercial |
$721.76
|
| Rate for Payer: WEA Trust Commercial |
$793.94
|
| Rate for Payer: WPS Commercial |
$1,069.18
|
|
|
Radiation Physics
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
3040391
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$844.32
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$974.22
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
Radiation Physics
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
3040391
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$636.49 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$779.38
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
RADIATION THERAPY MANAGEMENT
|
Facility
|
OP
|
$225.37
|
|
|
Service Code
|
EAPG 00483
|
| Min. Negotiated Rate |
$216.70 |
| Max. Negotiated Rate |
$225.37 |
| Rate for Payer: Anthem Medicaid |
$216.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$216.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.70
|
| Rate for Payer: Dean Health Medicaid |
$216.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$216.70
|
| Rate for Payer: Managed Health Services Medicaid |
$225.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$216.70
|
| Rate for Payer: United Healthcare Medicaid |
$216.70
|
|
|
Radiation Treatment Complex
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
3040399
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.48 |
| Max. Negotiated Rate |
$2,325.94 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Aetna Managed Medicare |
$581.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,035.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$828.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.33
|
| Rate for Payer: Anthem Medicare Advantage |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.48
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$932.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.48
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,163.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.48
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: NAPHCARE Commercial |
$872.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$1,082.95
|
| Rate for Payer: Quartz Medicare Advantage |
$581.48
|
| Rate for Payer: The Alliance Commercial |
$2,325.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.48
|
| Rate for Payer: United Healthcare PPO |
$1,249.56
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: Wellcare Medicare |
$581.48
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
Radiation Treatment Complex
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
3040399
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$816.38 |
| Max. Negotiated Rate |
$1,532.79 |
| Rate for Payer: Aetna Commercial |
$1,499.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,432.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$883.02
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,532.79
|
| Rate for Payer: Health EOS Commercial |
$1,482.81
|
| Rate for Payer: HFN Commercial |
$1,532.79
|
| Rate for Payer: Multiplan Commercial |
$1,332.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,532.79
|
| Rate for Payer: Quartz Beloit One Network |
$816.38
|
| Rate for Payer: Quartz Commercial |
$999.65
|
| Rate for Payer: WEA Trust Commercial |
$916.34
|
| Rate for Payer: WPS Commercial |
$1,234.02
|
|
|
Radiation TX Complex
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
3040402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$379.43 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Aetna Managed Medicare |
$379.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.35
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.34
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$813.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$880.83
|
| Rate for Payer: Quartz Medicare Advantage |
$813.07
|
| Rate for Payer: The Alliance Commercial |
$677.56
|
| Rate for Payer: United Healthcare PPO |
$1,016.34
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
Radiation TX Complex
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
3040402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$664.01 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$813.07
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
Radiation Tx Intermediate
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
3040398
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$405.90 |
| Max. Negotiated Rate |
$1,623.61 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$405.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,035.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$828.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.33
|
| Rate for Payer: Anthem Medicare Advantage |
$405.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$405.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$405.90
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$405.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$405.90
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,509.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$405.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$405.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$405.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$405.90
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$608.85
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$405.90
|
| Rate for Payer: The Alliance Commercial |
$1,623.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$405.90
|
| Rate for Payer: United Healthcare PPO |
$799.50
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: Wellcare Medicare |
$405.90
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
