|
SCHANZ PIN 5.0 TORNIER ZPSS5
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.69 |
| Max. Negotiated Rate |
$1,178.52 |
| Rate for Payer: Aetna Commercial |
$1,152.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.93
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna Commercial |
$1,178.52
|
| Rate for Payer: Health EOS Commercial |
$1,140.09
|
| Rate for Payer: HFN Commercial |
$1,178.52
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$768.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.52
|
| Rate for Payer: Quartz Beloit One Network |
$627.69
|
| Rate for Payer: Quartz Commercial |
$768.60
|
| Rate for Payer: WEA Trust Commercial |
$704.55
|
| Rate for Payer: WPS Commercial |
$948.84
|
|
|
Schistosoma Antibody (IgG), FMI
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Schistosoma Antibody (IgG), FMI
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.80
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: HFN Commercial |
$83.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Schistosoma Antibody (IgG), FMI
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
IP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,578.38 |
| Max. Negotiated Rate |
$4,841.04 |
| Rate for Payer: Aetna Commercial |
$4,735.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.86
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$4,841.04
|
| Rate for Payer: Health EOS Commercial |
$4,683.18
|
| Rate for Payer: HFN Commercial |
$4,841.04
|
| Rate for Payer: Multiplan Commercial |
$4,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.38
|
| Rate for Payer: Quartz Commercial |
$3,157.20
|
| Rate for Payer: WEA Trust Commercial |
$2,894.10
|
| Rate for Payer: WPS Commercial |
$3,897.56
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
OP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,473.36 |
| Max. Negotiated Rate |
$21,048.00 |
| Rate for Payer: Aetna Commercial |
$4,735.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,525.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,420.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,631.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,525.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.86
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$4,841.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,944.62
|
| Rate for Payer: Health EOS Commercial |
$4,683.18
|
| Rate for Payer: HFN Commercial |
$4,841.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,946.50
|
| Rate for Payer: Multiplan Commercial |
$4,209.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,841.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.38
|
| Rate for Payer: Quartz Commercial |
$3,420.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,157.20
|
| Rate for Payer: The Alliance Commercial |
$21,048.00
|
| Rate for Payer: WEA Trust Commercial |
$2,894.10
|
| Rate for Payer: WPS Commercial |
$3,897.56
|
|
|
SCISSOR GRIP HARMONIC ACE 5mm ACE14S
|
Facility
|
OP
|
$5,910.00
|
|
| Hospital Charge Code |
2974014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$23,640.00 |
| Rate for Payer: Aetna Commercial |
$5,319.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,082.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,654.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,841.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,955.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,836.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,132.30
|
| Rate for Payer: Cash Price |
$1,773.00
|
| Rate for Payer: Cigna Commercial |
$5,437.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,307.24
|
| Rate for Payer: Health EOS Commercial |
$5,259.90
|
| Rate for Payer: HFN Commercial |
$5,437.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,432.50
|
| Rate for Payer: Multiplan Commercial |
$4,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,437.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.90
|
| Rate for Payer: Quartz Commercial |
$3,841.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.00
|
| Rate for Payer: The Alliance Commercial |
$23,640.00
|
| Rate for Payer: WEA Trust Commercial |
$3,250.50
|
| Rate for Payer: WPS Commercial |
$4,377.54
|
|
|
SCISSOR GRIP HARMONIC ACE 5mm ACE14S
|
Facility
|
IP
|
$5,910.00
|
|
| Hospital Charge Code |
2974014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,895.90 |
| Max. Negotiated Rate |
$5,437.20 |
| Rate for Payer: Aetna Commercial |
$5,319.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,082.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,132.30
|
| Rate for Payer: Cash Price |
$1,773.00
|
| Rate for Payer: Cigna Commercial |
$5,437.20
|
| Rate for Payer: Health EOS Commercial |
$5,259.90
|
| Rate for Payer: HFN Commercial |
$5,437.20
|
| Rate for Payer: Multiplan Commercial |
$4,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,437.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.90
|
| Rate for Payer: Quartz Commercial |
$3,546.00
|
| Rate for Payer: WEA Trust Commercial |
$3,250.50
|
| Rate for Payer: WPS Commercial |
$4,377.54
|
|
|
SCISSORS ENDO BIPOLAR 5MM 5DCS
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
3633524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.42 |
| Max. Negotiated Rate |
$881.36 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$574.80
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
SCISSORS ENDO BIPOLAR 5MM 5DCS
|
Facility
|
OP
|
$958.00
|
|
| Hospital Charge Code |
3633524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$3,832.00 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Aetna Managed Medicare |
$268.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$622.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.10
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.50
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$622.70
|
| Rate for Payer: Quartz Medicare Advantage |
$574.80
|
| Rate for Payer: The Alliance Commercial |
$3,832.00
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
SCISSORS OSTOMY CRVD BLNT/BLNT
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
2963460
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.60
|
| Rate for Payer: The Alliance Commercial |
$684.00
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCISSORS OSTOMY CRVD BLNT/BLNT
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
2963460
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
SCISSORS SHAFT 34CM MINI 5MM
|
Facility
|
OP
|
$1,552.00
|
|
| Hospital Charge Code |
2962918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
SCISSORS SHAFT 34CM MINI 5MM
|
Facility
|
IP
|
$1,552.00
|
|
| Hospital Charge Code |
2962918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
Scl 70 Antibody
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna Commercial |
$187.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$187.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.20
|
| Rate for Payer: Health EOS Commercial |
$179.27
|
| Rate for Payer: HFN Commercial |
$187.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Preferred Network Access Commercial |
$187.15
|
| Rate for Payer: Quartz Beloit One Network |
$86.68
|
| Rate for Payer: Quartz Commercial |
$112.29
|
| Rate for Payer: The Alliance Commercial |
$98.50
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
Scl 70 Antibody
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$147.75
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
Scl 70 Antibody
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
Scl 70 to TheraTest
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Scl 70 to TheraTest
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$71.72 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Scl 70 to TheraTest
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$63.29 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.40
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: HFN Commercial |
$51.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Scleroderma Antibody (Scl 70)
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Scleroderma Antibody (Scl 70)
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Scleroderma Antibody (Scl 70)
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2942854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
SCLEROTHERAPY
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
2960563
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$435.12 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$532.80
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
|
SCLEROTHERAPY
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
2960563
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$799.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.68
|
| Rate for Payer: Aetna Managed Medicare |
$248.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.64
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$816.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.92
|
| Rate for Payer: Health EOS Commercial |
$790.32
|
| Rate for Payer: HFN Commercial |
$816.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.00
|
| Rate for Payer: Multiplan Commercial |
$710.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.80
|
| Rate for Payer: Preferred Network Access Commercial |
$816.96
|
| Rate for Payer: Quartz Beloit One Network |
$435.12
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: Quartz Medicare Advantage |
$532.80
|
| Rate for Payer: The Alliance Commercial |
$3,552.00
|
| Rate for Payer: WEA Trust Commercial |
$488.40
|
| Rate for Payer: WPS Commercial |
$657.74
|
|
