|
Risperidone
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Ristocetin Cofactor
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
Ristocetin Cofactor
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.60
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$95.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: United Healthcare PPO |
$256.62
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: Wellcare Medicare |
$23.86
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
Ristocetin Cofactor
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$325.05 |
| Rate for Payer: Aetna Commercial |
$325.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.86
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$325.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.86
|
| Rate for Payer: Health EOS Commercial |
$311.37
|
| Rate for Payer: HFN Commercial |
$325.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$35.79
|
| Rate for Payer: Preferred Network Access Commercial |
$325.05
|
| Rate for Payer: Quartz Beloit One Network |
$150.55
|
| Rate for Payer: Quartz Commercial |
$195.03
|
| Rate for Payer: Quartz Medicare Advantage |
$23.86
|
| Rate for Payer: The Alliance Commercial |
$94.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.86
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$104.97
|
|
|
Rituximab 10mg Injection J9312
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$77.76
|
| Rate for Payer: Anthem Medicare Advantage |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77.76
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.03
|
| Rate for Payer: Health EOS Commercial |
$256.47
|
| Rate for Payer: HFN Commercial |
$267.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$116.64
|
| Rate for Payer: Preferred Network Access Commercial |
$267.75
|
| Rate for Payer: Quartz Beloit One Network |
$124.01
|
| Rate for Payer: Quartz Commercial |
$160.65
|
| Rate for Payer: Quartz Medicare Advantage |
$77.76
|
| Rate for Payer: The Alliance Commercial |
$213.84
|
| Rate for Payer: United Healthcare Medicaid |
$77.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.76
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$205.07
|
|
|
Rituximab 10mg Injection J9312
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.76 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$77.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Anthem Medicare Advantage |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77.76
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$77.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$77.76
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$77.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$77.76
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$116.64
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$77.76
|
| Rate for Payer: The Alliance Commercial |
$311.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.76
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$77.76
|
| Rate for Payer: WPS Commercial |
$205.07
|
|
|
Rituximab 10mg Injection J9312
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
RLHC Coronaries BPG w/wo LV
|
Facility
|
OP
|
$23,908.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
3052501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$22,875.17 |
| Rate for Payer: Aetna Commercial |
$22,377.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,383.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,178.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cigna Commercial |
$22,875.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$22,129.24
|
| Rate for Payer: HFN Commercial |
$22,875.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$19,891.46
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$22,875.17
|
| Rate for Payer: Quartz Beloit One Network |
$12,183.52
|
| Rate for Payer: Quartz Commercial |
$16,161.81
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$13,675.38
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$18,416.33
|
|
|
RLHC Coronaries BPG w/wo LV
|
Facility
|
IP
|
$23,908.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
3052501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,183.52 |
| Max. Negotiated Rate |
$22,875.17 |
| Rate for Payer: Aetna Commercial |
$22,377.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,383.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,178.09
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cigna Commercial |
$22,875.17
|
| Rate for Payer: Health EOS Commercial |
$22,129.24
|
| Rate for Payer: HFN Commercial |
$22,875.17
|
| Rate for Payer: Multiplan Commercial |
$19,891.46
|
| Rate for Payer: Preferred Network Access Commercial |
$22,875.17
|
| Rate for Payer: Quartz Beloit One Network |
$12,183.52
|
| Rate for Payer: Quartz Commercial |
$14,918.59
|
| Rate for Payer: WEA Trust Commercial |
$13,675.38
|
| Rate for Payer: WPS Commercial |
$18,416.33
|
|
|
RLHC Coronaries w/wo LV
|
Facility
|
IP
|
$22,299.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
3052500
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,363.57 |
| Max. Negotiated Rate |
$21,335.68 |
| Rate for Payer: Aetna Commercial |
$20,871.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,944.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,291.21
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cigna Commercial |
$21,335.68
|
| Rate for Payer: Health EOS Commercial |
$20,639.95
|
| Rate for Payer: HFN Commercial |
$21,335.68
|
| Rate for Payer: Multiplan Commercial |
$18,552.77
|
| Rate for Payer: Preferred Network Access Commercial |
$21,335.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,363.57
|
| Rate for Payer: Quartz Commercial |
$13,914.58
|
| Rate for Payer: WEA Trust Commercial |
$12,755.03
|
| Rate for Payer: WPS Commercial |
$17,176.92
|
|
|
RLHC Coronaries w/wo LV
|
Facility
|
OP
|
$22,299.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
3052500
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$21,335.68 |
| Rate for Payer: Aetna Commercial |
$20,871.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,944.23
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,291.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cigna Commercial |
$21,335.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$20,639.95
|
| Rate for Payer: HFN Commercial |
$21,335.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$18,552.77
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$21,335.68
|
| Rate for Payer: Quartz Beloit One Network |
$11,363.57
|
| Rate for Payer: Quartz Commercial |
$15,074.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$12,755.03
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$17,176.92
|
|
|
RLHC w/wo LV
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
3052493
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,541.59 |
| Max. Negotiated Rate |
$19,792.36 |
| Rate for Payer: Aetna Commercial |
$19,362.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,501.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,402.12
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cigna Commercial |
$19,792.36
|
| Rate for Payer: Health EOS Commercial |
$19,146.96
|
| Rate for Payer: HFN Commercial |
$19,792.36
|
| Rate for Payer: Multiplan Commercial |
$17,210.75
|
| Rate for Payer: Preferred Network Access Commercial |
$19,792.36
|
| Rate for Payer: Quartz Beloit One Network |
$10,541.59
|
| Rate for Payer: Quartz Commercial |
$12,908.06
|
| Rate for Payer: WEA Trust Commercial |
$11,832.39
|
| Rate for Payer: WPS Commercial |
$15,934.43
|
|
|
RLHC w/wo LV
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
3052493
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$19,792.36 |
| Rate for Payer: Aetna Commercial |
$19,362.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,501.56
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,402.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cigna Commercial |
$19,792.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$19,146.96
|
| Rate for Payer: HFN Commercial |
$19,792.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$17,210.75
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19,792.36
|
| Rate for Payer: Quartz Beloit One Network |
$10,541.59
|
| Rate for Payer: Quartz Commercial |
$13,983.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$11,832.39
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$15,934.43
|
|
|
Rmvl Foreign Body Upper Arm/Elbow Sub 24200
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
4598815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$617.39 |
| Rate for Payer: Aetna Commercial |
$508.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.62
|
| Rate for Payer: Aetna Managed Medicare |
$137.20
|
| Rate for Payer: Anthem Medicare Advantage |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.20
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$508.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.20
|
| Rate for Payer: Health EOS Commercial |
$487.40
|
| Rate for Payer: HFN Commercial |
$508.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$489.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$489.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$428.48
|
| Rate for Payer: NAPHCARE Commercial |
$205.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.82
|
| Rate for Payer: Quartz Beloit One Network |
$235.66
|
| Rate for Payer: Quartz Commercial |
$305.29
|
| Rate for Payer: Quartz Medicare Advantage |
$137.20
|
| Rate for Payer: The Alliance Commercial |
$583.09
|
| Rate for Payer: United Healthcare Medicaid |
$66.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.20
|
| Rate for Payer: WEA Trust Commercial |
$294.58
|
| Rate for Payer: WPS Commercial |
$617.39
|
|
|
RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR 49623
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
CPT 49623
|
| Hospital Charge Code |
6179924
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.99 |
| Max. Negotiated Rate |
$2,029.35 |
| Rate for Payer: Aetna Commercial |
$2,029.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.10
|
| Rate for Payer: Aetna Managed Medicare |
$167.25
|
| Rate for Payer: Anthem Medicare Advantage |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.25
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$2,029.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.25
|
| Rate for Payer: Health EOS Commercial |
$1,943.91
|
| Rate for Payer: HFN Commercial |
$2,029.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$1,708.93
|
| Rate for Payer: NAPHCARE Commercial |
$250.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.35
|
| Rate for Payer: Quartz Beloit One Network |
$939.91
|
| Rate for Payer: Quartz Commercial |
$1,217.61
|
| Rate for Payer: Quartz Medicare Advantage |
$167.25
|
| Rate for Payer: The Alliance Commercial |
$710.82
|
| Rate for Payer: United Healthcare Medicaid |
$144.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$1,174.89
|
| Rate for Payer: WPS Commercial |
$752.64
|
|
|
RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR, EXT 4962322
|
Professional
|
Both
|
$2,465.00
|
|
|
Service Code
|
CPT 49623 22
|
| Hospital Charge Code |
6196919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.99 |
| Max. Negotiated Rate |
$2,435.42 |
| Rate for Payer: Aetna Commercial |
$2,435.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.70
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cigna Commercial |
$2,435.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,538.16
|
| Rate for Payer: Health EOS Commercial |
$2,332.88
|
| Rate for Payer: HFN Commercial |
$2,435.42
|
| Rate for Payer: Multiplan Commercial |
$2,050.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,435.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.98
|
| Rate for Payer: Quartz Commercial |
$1,461.25
|
| Rate for Payer: The Alliance Commercial |
$1,281.80
|
| Rate for Payer: United Healthcare Medicaid |
$144.99
|
| Rate for Payer: WEA Trust Commercial |
$1,409.98
|
| Rate for Payer: WPS Commercial |
$1,898.79
|
|
|
Rmvl Spinal Nstim Eltrd Prq Array Incl Fluor 63661
|
Professional
|
Both
|
$2,222.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
5426706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$292.92 |
| Max. Negotiated Rate |
$2,195.34 |
| Rate for Payer: Aetna Commercial |
$2,195.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,987.36
|
| Rate for Payer: Aetna Managed Medicare |
$292.92
|
| Rate for Payer: Anthem Medicare Advantage |
$292.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.92
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$2,195.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$472.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.92
|
| Rate for Payer: Health EOS Commercial |
$2,102.90
|
| Rate for Payer: HFN Commercial |
$2,195.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,120.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.92
|
| Rate for Payer: Multiplan Commercial |
$1,848.70
|
| Rate for Payer: NAPHCARE Commercial |
$439.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,195.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,016.79
|
| Rate for Payer: Quartz Commercial |
$1,317.20
|
| Rate for Payer: Quartz Medicare Advantage |
$292.92
|
| Rate for Payer: The Alliance Commercial |
$1,244.89
|
| Rate for Payer: United Healthcare Medicaid |
$472.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.92
|
| Rate for Payer: WEA Trust Commercial |
$1,270.98
|
| Rate for Payer: WPS Commercial |
$1,318.12
|
|
|
RNA Polymerase III Ab
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
RNA Polymerase III Ab
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
RNA Polymerase III Ab
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
RNP Antibody
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
RNP Antibody
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
RNP Antibody
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
RNP/SM to TheraTest
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
RNP/SM to TheraTest
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
