|
Schistosoma Antibody (IgG), FMI
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5242622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$59.53
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$6,751.60
|
|
|
Service Code
|
APR-DRG 7611
|
| Min. Negotiated Rate |
$5,997.19 |
| Max. Negotiated Rate |
$6,751.60 |
| Rate for Payer: Anthem Medicaid |
$6,465.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,465.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,465.03
|
| Rate for Payer: Dean Health Medicaid |
$6,465.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,997.19
|
| Rate for Payer: Managed Health Services Medicaid |
$6,751.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,465.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,465.03
|
| Rate for Payer: United Healthcare Medicaid |
$6,465.03
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$13,064.78
|
|
|
Service Code
|
APR-DRG 7613
|
| Min. Negotiated Rate |
$11,604.95 |
| Max. Negotiated Rate |
$13,064.78 |
| Rate for Payer: Anthem Medicaid |
$12,510.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,510.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,510.25
|
| Rate for Payer: Dean Health Medicaid |
$12,510.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,604.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13,064.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,510.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,510.25
|
| Rate for Payer: United Healthcare Medicaid |
$12,510.25
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 7612
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
SCHIZOAFFECTIVE DISORDERS
|
Facility
|
IP
|
$22,534.56
|
|
|
Service Code
|
APR-DRG 7614
|
| Min. Negotiated Rate |
$20,016.60 |
| Max. Negotiated Rate |
$22,534.56 |
| Rate for Payer: Anthem Medicaid |
$21,578.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,578.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,578.08
|
| Rate for Payer: Dean Health Medicaid |
$21,578.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,016.60
|
| Rate for Payer: Managed Health Services Medicaid |
$22,534.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,578.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,578.08
|
| Rate for Payer: United Healthcare Medicaid |
$21,578.08
|
|
|
SCHIZOPHRENIA
|
Facility
|
OP
|
$47.45
|
|
|
Service Code
|
EAPG 00820
|
| Min. Negotiated Rate |
$45.63 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Anthem Medicaid |
$45.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.63
|
| Rate for Payer: Dean Health Medicaid |
$45.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$45.63
|
| Rate for Payer: Managed Health Services Medicaid |
$47.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45.63
|
| Rate for Payer: United Healthcare Medicaid |
$45.63
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$20,956.26
|
|
|
Service Code
|
APR-DRG 7504
|
| Min. Negotiated Rate |
$18,614.66 |
| Max. Negotiated Rate |
$20,956.26 |
| Rate for Payer: Anthem Medicaid |
$20,066.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,066.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,066.77
|
| Rate for Payer: Dean Health Medicaid |
$20,066.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,614.66
|
| Rate for Payer: Managed Health Services Medicaid |
$20,956.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,066.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,066.77
|
| Rate for Payer: United Healthcare Medicaid |
$20,066.77
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 7502
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 7501
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
SCHIZOPHRENIA AND OTHER SEVERE PSYCHOTIC DISORDERS
|
Facility
|
IP
|
$10,872.70
|
|
|
Service Code
|
APR-DRG 7503
|
| Min. Negotiated Rate |
$9,657.81 |
| Max. Negotiated Rate |
$10,872.70 |
| Rate for Payer: Anthem Medicaid |
$10,411.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,411.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,411.21
|
| Rate for Payer: Dean Health Medicaid |
$10,411.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,657.81
|
| Rate for Payer: Managed Health Services Medicaid |
$10,872.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,411.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,411.21
|
| Rate for Payer: United Healthcare Medicaid |
$10,411.21
|
|
|
SCIATICA
|
Facility
|
OP
|
$34.63
|
|
|
Service Code
|
EAPG 00658
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$34.63 |
| Rate for Payer: Anthem Medicaid |
$33.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.29
|
| Rate for Payer: Dean Health Medicaid |
$33.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33.29
|
| Rate for Payer: Managed Health Services Medicaid |
$34.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33.29
|
| Rate for Payer: United Healthcare Medicaid |
$33.29
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
IP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,681.52 |
| Max. Negotiated Rate |
$5,034.68 |
| Rate for Payer: Aetna Commercial |
$4,925.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,706.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.41
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$5,034.68
|
| Rate for Payer: Health EOS Commercial |
$4,870.51
|
| Rate for Payer: HFN Commercial |
$5,034.68
|
| Rate for Payer: Multiplan Commercial |
$4,377.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,034.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.52
|
| Rate for Payer: Quartz Commercial |
$3,283.49
|
| Rate for Payer: WEA Trust Commercial |
$3,009.86
|
| Rate for Payer: WPS Commercial |
$4,053.32
|
|
|
SCISSOR 5MM HARMONIC ACE145
|
Facility
|
OP
|
$5,262.00
|
|
| Hospital Charge Code |
2969370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,532.29 |
| Max. Negotiated Rate |
$5,034.68 |
| Rate for Payer: Aetna Commercial |
$4,925.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,706.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,557.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,736.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,626.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.41
|
| Rate for Payer: Cash Price |
$1,578.60
|
| Rate for Payer: Cigna Commercial |
$5,034.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,062.48
|
| Rate for Payer: Health EOS Commercial |
$4,870.51
|
| Rate for Payer: HFN Commercial |
$5,034.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,104.36
|
| Rate for Payer: Multiplan Commercial |
$4,377.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,283.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,034.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,681.52
|
| Rate for Payer: Quartz Commercial |
$3,557.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,283.49
|
| Rate for Payer: The Alliance Commercial |
$2,736.24
|
| Rate for Payer: WEA Trust Commercial |
$3,009.86
|
| Rate for Payer: WPS Commercial |
$4,053.32
|
|
|
SCISSOR GRIP HARMONIC ACE 5mm ACE14S
|
Facility
|
OP
|
$5,910.00
|
|
| Hospital Charge Code |
2974014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,720.99 |
| Max. Negotiated Rate |
$5,654.69 |
| Rate for Payer: Aetna Commercial |
$5,531.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,285.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,720.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,995.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,073.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,950.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,257.59
|
| Rate for Payer: Cash Price |
$1,773.00
|
| Rate for Payer: Cigna Commercial |
$5,654.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,439.62
|
| Rate for Payer: Health EOS Commercial |
$5,470.30
|
| Rate for Payer: HFN Commercial |
$5,654.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,609.80
|
| Rate for Payer: Multiplan Commercial |
$4,917.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,687.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,654.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.74
|
| Rate for Payer: Quartz Commercial |
$3,995.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,687.84
|
| Rate for Payer: The Alliance Commercial |
$3,073.20
|
| Rate for Payer: WEA Trust Commercial |
$3,380.52
|
| Rate for Payer: WPS Commercial |
$4,552.47
|
|
|
SCISSOR GRIP HARMONIC ACE 5mm ACE14S
|
Facility
|
IP
|
$5,910.00
|
|
| Hospital Charge Code |
2974014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,011.74 |
| Max. Negotiated Rate |
$5,654.69 |
| Rate for Payer: Aetna Commercial |
$5,531.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,285.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,257.59
|
| Rate for Payer: Cash Price |
$1,773.00
|
| Rate for Payer: Cigna Commercial |
$5,654.69
|
| Rate for Payer: Health EOS Commercial |
$5,470.30
|
| Rate for Payer: HFN Commercial |
$5,654.69
|
| Rate for Payer: Multiplan Commercial |
$4,917.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,654.69
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.74
|
| Rate for Payer: Quartz Commercial |
$3,687.84
|
| Rate for Payer: WEA Trust Commercial |
$3,380.52
|
| Rate for Payer: WPS Commercial |
$4,552.47
|
|
|
SCISSORS ENDO BIPOLAR 5MM 5DCS
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
3633524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCISSORS ENDO BIPOLAR 5MM 5DCS
|
Facility
|
OP
|
$958.00
|
|
| Hospital Charge Code |
3633524
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
SCISSORS OSTOMY CRVD BLNT/BLNT
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
2963460
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCISSORS OSTOMY CRVD BLNT/BLNT
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
2963460
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
SCISSORS SHAFT 34CM MINI 5MM
|
Facility
|
OP
|
$1,552.00
|
|
| Hospital Charge Code |
2962918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SCISSORS SHAFT 34CM MINI 5MM
|
Facility
|
IP
|
$1,552.00
|
|
| Hospital Charge Code |
2962918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
Scl 70 Antibody
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| 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 |
$108.59
|
| 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 |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| 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 |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| 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 |
$153.66
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
Scl 70 Antibody
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
Scl 70 Antibody
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| 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 |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| 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 |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| 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 |
$112.68
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
Scl 70 to TheraTest
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| 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 |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| 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 |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| 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 |
$30.89
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
