|
Rad Therapy Tx Plan-Complex 77263
|
Professional
|
Both
|
$2,776.00
|
|
|
Service Code
|
CPT 77263
|
| Hospital Charge Code |
5258623
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.76 |
| Max. Negotiated Rate |
$2,742.69 |
| Rate for Payer: Aetna Commercial |
$2,742.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Aetna Managed Medicare |
$166.76
|
| Rate for Payer: Anthem Medicare Advantage |
$166.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.76
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,742.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,443.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.76
|
| Rate for Payer: Health EOS Commercial |
$2,627.21
|
| Rate for Payer: HFN Commercial |
$2,742.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$592.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.76
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: NAPHCARE Commercial |
$250.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,742.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.30
|
| Rate for Payer: Quartz Commercial |
$1,645.61
|
| Rate for Payer: Quartz Medicare Advantage |
$166.76
|
| Rate for Payer: The Alliance Commercial |
$633.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.76
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$833.82
|
|
|
Rad Therapy Tx Plan-Intermediate 77262
|
Professional
|
Both
|
$1,849.00
|
|
|
Service Code
|
CPT 77262
|
| Hospital Charge Code |
5258622
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$1,826.81 |
| Rate for Payer: Aetna Commercial |
$1,826.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,653.75
|
| Rate for Payer: Aetna Managed Medicare |
$106.95
|
| Rate for Payer: Anthem Medicare Advantage |
$106.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.95
|
| Rate for Payer: Cash Price |
$554.70
|
| Rate for Payer: Cash Price |
$554.70
|
| Rate for Payer: Cash Price |
$554.70
|
| Rate for Payer: Cigna Commercial |
$1,826.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$961.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.95
|
| Rate for Payer: Health EOS Commercial |
$1,749.89
|
| Rate for Payer: HFN Commercial |
$1,826.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.95
|
| Rate for Payer: Multiplan Commercial |
$1,538.37
|
| Rate for Payer: NAPHCARE Commercial |
$160.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,826.81
|
| Rate for Payer: Quartz Beloit One Network |
$846.10
|
| Rate for Payer: Quartz Commercial |
$1,096.09
|
| Rate for Payer: Quartz Medicare Advantage |
$106.95
|
| Rate for Payer: The Alliance Commercial |
$406.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.95
|
| Rate for Payer: WEA Trust Commercial |
$1,057.63
|
| Rate for Payer: WPS Commercial |
$534.77
|
|
|
Rad Therapy Tx Plan-Simple 77261
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
CPT 77261
|
| Hospital Charge Code |
5258621
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.83 |
| Max. Negotiated Rate |
$1,233.02 |
| Rate for Payer: Aetna Commercial |
$1,233.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.21
|
| Rate for Payer: Aetna Managed Medicare |
$69.83
|
| Rate for Payer: Anthem Medicare Advantage |
$69.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.83
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$1,233.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$648.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.83
|
| Rate for Payer: Health EOS Commercial |
$1,181.11
|
| Rate for Payer: HFN Commercial |
$1,233.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$250.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.83
|
| Rate for Payer: Multiplan Commercial |
$1,038.34
|
| Rate for Payer: NAPHCARE Commercial |
$104.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,233.02
|
| Rate for Payer: Quartz Beloit One Network |
$571.08
|
| Rate for Payer: Quartz Commercial |
$739.81
|
| Rate for Payer: Quartz Medicare Advantage |
$69.83
|
| Rate for Payer: The Alliance Commercial |
$265.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.83
|
| Rate for Payer: WEA Trust Commercial |
$713.86
|
| Rate for Payer: WPS Commercial |
$349.13
|
|
|
RAID
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
6209192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.39
|
| Rate for Payer: Anthem Medicare Advantage |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.39
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.39
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.39
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$12.59
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.39
|
| Rate for Payer: The Alliance Commercial |
$33.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.39
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$36.93
|
|
|
RAID
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
6209192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.93
|
| Rate for Payer: Anthem Medicare Advantage |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.39
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.39
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.39
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$12.59
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$8.39
|
| Rate for Payer: The Alliance Commercial |
$33.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.39
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$8.39
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
RAID
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
6209192
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Range of Motion Measurements 95851
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
3015468
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$52.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$6.67
|
| Rate for Payer: Anthem Medicare Advantage |
$6.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.67
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.67
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.67
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$10.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6.67
|
| Rate for Payer: The Alliance Commercial |
$16.67
|
| Rate for Payer: United Healthcare Medicaid |
$17.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.67
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
Ranibizumab Injection J2778
|
Facility
|
IP
|
$1,124.00
|
|
|
Service Code
|
HCPCS J2778
|
| Hospital Charge Code |
5246757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$572.79 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$701.38
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$865.82
|
|
|
Ranibizumab Injection J2778
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
HCPCS J2778
|
| Hospital Charge Code |
5246757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.06 |
| Max. Negotiated Rate |
$1,075.44 |
| Rate for Payer: Aetna Commercial |
$1,052.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Aetna Managed Medicare |
$68.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$759.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$584.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$561.10
|
| Rate for Payer: Anthem Medicare Advantage |
$68.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.06
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,075.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$68.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$68.06
|
| Rate for Payer: Health EOS Commercial |
$1,040.37
|
| Rate for Payer: HFN Commercial |
$1,075.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$68.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$68.06
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: NAPHCARE Commercial |
$102.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.44
|
| Rate for Payer: Quartz Beloit One Network |
$572.79
|
| Rate for Payer: Quartz Commercial |
$759.82
|
| Rate for Payer: Quartz Medicare Advantage |
$68.06
|
| Rate for Payer: The Alliance Commercial |
$272.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.06
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: Wellcare Medicare |
$68.06
|
| Rate for Payer: WPS Commercial |
$450.78
|
|
|
Ranibizumab Injection J2778
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS J2778
|
| Hospital Charge Code |
5246757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.06 |
| Max. Negotiated Rate |
$1,110.51 |
| Rate for Payer: Aetna Commercial |
$1,110.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,005.31
|
| Rate for Payer: Aetna Managed Medicare |
$68.06
|
| Rate for Payer: Anthem Medicare Advantage |
$68.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.06
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,110.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.31
|
| Rate for Payer: Health EOS Commercial |
$1,063.75
|
| Rate for Payer: HFN Commercial |
$1,110.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.06
|
| Rate for Payer: Multiplan Commercial |
$935.17
|
| Rate for Payer: NAPHCARE Commercial |
$102.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.51
|
| Rate for Payer: Quartz Beloit One Network |
$514.34
|
| Rate for Payer: Quartz Commercial |
$666.31
|
| Rate for Payer: Quartz Medicare Advantage |
$68.06
|
| Rate for Payer: The Alliance Commercial |
$187.16
|
| Rate for Payer: United Healthcare Medicaid |
$68.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.06
|
| Rate for Payer: WEA Trust Commercial |
$642.93
|
| Rate for Payer: WPS Commercial |
$450.78
|
|
|
Rapamycin (Sirolimus)
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: United Healthcare PPO |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: Wellcare Medicare |
$14.28
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Rapamycin (Sirolimus)
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Rapamycin (Sirolimus)
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$262.81 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$56.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$62.83
|
|
|
Rapid Anaerobe ID
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
Rapid Anaerobe ID
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$202.54 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Rapid Anaerobe ID
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: United Healthcare PPO |
$159.90
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: Wellcare Medicare |
$8.40
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
Rapid Desensitization 95180
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
4586645
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$484.12 |
| Rate for Payer: Aetna Commercial |
$348.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.72
|
| Rate for Payer: Aetna Managed Medicare |
$87.87
|
| Rate for Payer: Anthem Medicare Advantage |
$87.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.87
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$348.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.87
|
| Rate for Payer: Health EOS Commercial |
$334.08
|
| Rate for Payer: HFN Commercial |
$348.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$484.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.87
|
| Rate for Payer: Multiplan Commercial |
$293.70
|
| Rate for Payer: NAPHCARE Commercial |
$131.80
|
| Rate for Payer: Preferred Network Access Commercial |
$348.76
|
| Rate for Payer: Quartz Beloit One Network |
$161.53
|
| Rate for Payer: Quartz Commercial |
$209.26
|
| Rate for Payer: Quartz Medicare Advantage |
$87.87
|
| Rate for Payer: The Alliance Commercial |
$219.67
|
| Rate for Payer: United Healthcare Medicaid |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.87
|
| Rate for Payer: WEA Trust Commercial |
$201.92
|
| Rate for Payer: WPS Commercial |
$351.48
|
|
|
Rapid Neg Urine Combo Panel 1
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
Rapid Neg Urine Combo Panel 1
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Rapid Neg Urine Combo Panel 1
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Rapid Plasma Reagin Test
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Rapid Plasma Reagin Test
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Rapid Plasma Reagin Test
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
RAPID REFILL CONTINUOUS 6600
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2973232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
RAPID REFILL CONTINUOUS 6600
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2973232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
