|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 11732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
|
|
Awake Maintenance Test(MWT)
|
Facility
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3101729
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,852.69 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,268.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,268.60
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
Awake Maintenance Test(MWT)
|
Facility
OP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3101729
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,251.66
|
| Rate for Payer: Aetna Managed Medicare |
$529.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.77
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$529.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,115.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$529.77
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$529.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$529.77
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$794.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,457.65
|
| Rate for Payer: Quartz Medicare Advantage |
$529.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.77
|
| Rate for Payer: United Healthcare PPO |
$2,835.75
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: Wellcare Medicare |
$529.77
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
AXILLARY BLOCK - SET-UP CHARGE
|
Facility
IP
|
$1,325.00
|
|
| Hospital Charge Code |
4519589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$649.25 |
| Max. Negotiated Rate |
$1,219.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$795.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
AXILLARY BLOCK - SET-UP CHARGE
|
Facility
OP
|
$1,325.00
|
|
| Hospital Charge Code |
4519589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna Commercial |
$1,192.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.50
|
| Rate for Payer: Aetna Managed Medicare |
$371.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.25
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.25
|
| Rate for Payer: HFN Commercial |
$1,219.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.75
|
| Rate for Payer: Multiplan Commercial |
$1,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$795.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.00
|
| Rate for Payer: Quartz Beloit One Network |
$649.25
|
| Rate for Payer: Quartz Commercial |
$861.25
|
| Rate for Payer: Quartz Medicare Advantage |
$795.00
|
| Rate for Payer: The Alliance Commercial |
$5,300.00
|
| Rate for Payer: WEA Trust Commercial |
$728.75
|
| Rate for Payer: WPS Commercial |
$981.43
|
|
|
AXILLARY LYMPH NODE DISSECTION
|
Facility
IP
|
$1,090.00
|
|
| Hospital Charge Code |
2959839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$534.10 |
| Max. Negotiated Rate |
$1,002.80 |
| Rate for Payer: Aetna Commercial |
$981.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.70
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$970.10
|
| Rate for Payer: HFN Commercial |
$1,002.80
|
| Rate for Payer: Multiplan Commercial |
$872.00
|
| Rate for Payer: NAPHCARE Commercial |
$654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.80
|
| Rate for Payer: Quartz Beloit One Network |
$534.10
|
| Rate for Payer: Quartz Commercial |
$654.00
|
| Rate for Payer: WEA Trust Commercial |
$599.50
|
| Rate for Payer: WPS Commercial |
$807.36
|
|
|
AXILLARY LYMPH NODE DISSECTION
|
Facility
OP
|
$1,090.00
|
|
| Hospital Charge Code |
2959839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$4,360.00 |
| Rate for Payer: Aetna Commercial |
$981.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.40
|
| Rate for Payer: Aetna Managed Medicare |
$305.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$545.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$523.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.70
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$1,002.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$609.96
|
| Rate for Payer: Health EOS Commercial |
$970.10
|
| Rate for Payer: HFN Commercial |
$1,002.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.50
|
| Rate for Payer: Multiplan Commercial |
$872.00
|
| Rate for Payer: NAPHCARE Commercial |
$654.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.80
|
| Rate for Payer: Quartz Beloit One Network |
$534.10
|
| Rate for Payer: Quartz Commercial |
$708.50
|
| Rate for Payer: Quartz Medicare Advantage |
$654.00
|
| Rate for Payer: The Alliance Commercial |
$4,360.00
|
| Rate for Payer: WEA Trust Commercial |
$599.50
|
| Rate for Payer: WPS Commercial |
$807.36
|
|
|
AXILLO FEMORAL BYPASS GRAFT
|
Facility
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2959837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,353.44 |
| Max. Negotiated Rate |
$62,192.00 |
| Rate for Payer: Aetna Commercial |
$13,993.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,371.28
|
| Rate for Payer: Aetna Managed Medicare |
$4,353.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,106.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,774.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,463.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,240.44
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,304.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,700.66
|
| Rate for Payer: Health EOS Commercial |
$13,837.72
|
| Rate for Payer: HFN Commercial |
$14,304.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,661.00
|
| Rate for Payer: Multiplan Commercial |
$12,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,618.52
|
| Rate for Payer: Quartz Commercial |
$10,106.20
|
| Rate for Payer: Quartz Medicare Advantage |
$9,328.80
|
| Rate for Payer: The Alliance Commercial |
$62,192.00
|
| Rate for Payer: WEA Trust Commercial |
$8,551.40
|
| Rate for Payer: WPS Commercial |
$11,516.40
|
|
|
AXILLO FEMORAL BYPASS GRAFT
|
Facility
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2959837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,618.52 |
| Max. Negotiated Rate |
$14,304.16 |
| Rate for Payer: Aetna Commercial |
$13,993.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,240.44
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,304.16
|
| Rate for Payer: Health EOS Commercial |
$13,837.72
|
| Rate for Payer: HFN Commercial |
$14,304.16
|
| Rate for Payer: Multiplan Commercial |
$12,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,618.52
|
| Rate for Payer: Quartz Commercial |
$9,328.80
|
| Rate for Payer: WEA Trust Commercial |
$8,551.40
|
| Rate for Payer: WPS Commercial |
$11,516.40
|
|
|
AXILLO FEMORAL FEMORAL BYPASS GRAFT
|
Facility
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2959838
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,618.52 |
| Max. Negotiated Rate |
$14,304.16 |
| Rate for Payer: Aetna Commercial |
$13,993.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,240.44
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,304.16
|
| Rate for Payer: Health EOS Commercial |
$13,837.72
|
| Rate for Payer: HFN Commercial |
$14,304.16
|
| Rate for Payer: Multiplan Commercial |
$12,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,618.52
|
| Rate for Payer: Quartz Commercial |
$9,328.80
|
| Rate for Payer: WEA Trust Commercial |
$8,551.40
|
| Rate for Payer: WPS Commercial |
$11,516.40
|
|
|
AXILLO FEMORAL FEMORAL BYPASS GRAFT
|
Facility
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2959838
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,353.44 |
| Max. Negotiated Rate |
$62,192.00 |
| Rate for Payer: Aetna Commercial |
$13,993.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,371.28
|
| Rate for Payer: Aetna Managed Medicare |
$4,353.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,106.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,774.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,463.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,240.44
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,304.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,700.66
|
| Rate for Payer: Health EOS Commercial |
$13,837.72
|
| Rate for Payer: HFN Commercial |
$14,304.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,661.00
|
| Rate for Payer: Multiplan Commercial |
$12,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,328.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,618.52
|
| Rate for Payer: Quartz Commercial |
$10,106.20
|
| Rate for Payer: Quartz Medicare Advantage |
$9,328.80
|
| Rate for Payer: The Alliance Commercial |
$62,192.00
|
| Rate for Payer: WEA Trust Commercial |
$8,551.40
|
| Rate for Payer: WPS Commercial |
$11,516.40
|
|
|
Axumin
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$319.48 |
| Max. Negotiated Rate |
$1,049.72 |
| Rate for Payer: Aetna Commercial |
$1,026.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.26
|
| Rate for Payer: Aetna Managed Medicare |
$319.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$741.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$570.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$547.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.73
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,049.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$638.50
|
| Rate for Payer: Health EOS Commercial |
$1,015.49
|
| Rate for Payer: HFN Commercial |
$1,049.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.75
|
| Rate for Payer: Multiplan Commercial |
$912.80
|
| Rate for Payer: NAPHCARE Commercial |
$684.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.72
|
| Rate for Payer: Quartz Beloit One Network |
$559.09
|
| Rate for Payer: Quartz Commercial |
$741.65
|
| Rate for Payer: Quartz Medicare Advantage |
$684.60
|
| Rate for Payer: WEA Trust Commercial |
$627.55
|
| Rate for Payer: WPS Commercial |
$845.14
|
|
|
Axumin
|
Professional
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$502.04 |
| Max. Negotiated Rate |
$1,083.95 |
| Rate for Payer: Aetna Commercial |
$1,083.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$981.26
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,083.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$570.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$684.60
|
| Rate for Payer: Health EOS Commercial |
$1,038.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.68
|
| Rate for Payer: Multiplan Commercial |
$912.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.95
|
| Rate for Payer: Quartz Beloit One Network |
$502.04
|
| Rate for Payer: Quartz Commercial |
$650.37
|
| Rate for Payer: The Alliance Commercial |
$570.50
|
| Rate for Payer: WEA Trust Commercial |
$627.55
|
| Rate for Payer: WPS Commercial |
$845.14
|
|
|
Axumin
|
Facility
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$559.09 |
| Max. Negotiated Rate |
$1,049.72 |
| Rate for Payer: Aetna Commercial |
$1,026.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$604.73
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,049.72
|
| Rate for Payer: Health EOS Commercial |
$1,015.49
|
| Rate for Payer: HFN Commercial |
$1,049.72
|
| Rate for Payer: Multiplan Commercial |
$912.80
|
| Rate for Payer: NAPHCARE Commercial |
$684.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.72
|
| Rate for Payer: Quartz Beloit One Network |
$559.09
|
| Rate for Payer: Quartz Commercial |
$684.60
|
| Rate for Payer: WEA Trust Commercial |
$627.55
|
| Rate for Payer: WPS Commercial |
$845.14
|
|
|
Azithromycin 500mg vial [Med]
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
2975000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$933.88 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$20.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.19
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.75
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$43.80
|
| Rate for Payer: The Alliance Commercial |
$933.88
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$6.02
|
|
|
Azithromycin 500mg vial [Med]
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
2975000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Professional
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$100.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$111.98
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Professional
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$100.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$111.98
|
|
|
B2 Glycoprotein 1 Antibody IgM
|
Professional
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$100.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$111.98
|
|
|
B2 Glycoprotein 1 Antibody IgM
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
