|
Sex Hormone Binding Globulin
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$189.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.40
|
| Rate for Payer: Health EOS Commercial |
$181.09
|
| Rate for Payer: HFN Commercial |
$189.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$189.05
|
| Rate for Payer: Quartz Beloit One Network |
$87.56
|
| Rate for Payer: Quartz Commercial |
$113.43
|
| Rate for Payer: The Alliance Commercial |
$99.50
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$272.32 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$156.88
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$272.32
|
| Rate for Payer: Health EOS Commercial |
$263.44
|
| Rate for Payer: HFN Commercial |
$272.32
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: NAPHCARE Commercial |
$177.60
|
| Rate for Payer: Preferred Network Access Commercial |
$272.32
|
| Rate for Payer: Quartz Beloit One Network |
$145.04
|
| Rate for Payer: Quartz Commercial |
$177.60
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Sex Hormone Binding Globulin
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$281.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.60
|
| Rate for Payer: Health EOS Commercial |
$269.36
|
| Rate for Payer: HFN Commercial |
$281.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Preferred Network Access Commercial |
$281.20
|
| Rate for Payer: Quartz Beloit One Network |
$130.24
|
| Rate for Payer: Quartz Commercial |
$168.72
|
| Rate for Payer: The Alliance Commercial |
$148.00
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
978066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$272.32 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| Rate for Payer: Aetna Managed Medicare |
$21.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.07
|
| Rate for Payer: Anthem Medicaid |
$22.45
|
| Rate for Payer: Anthem Medicare Advantage |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$156.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.73
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$272.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.64
|
| Rate for Payer: Dean Health Medicaid |
$22.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.73
|
| Rate for Payer: Health EOS Commercial |
$263.44
|
| Rate for Payer: HFN Commercial |
$272.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.73
|
| Rate for Payer: Managed Health Services Medicaid |
$23.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.73
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.60
|
| Rate for Payer: Preferred Network Access Commercial |
$272.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.45
|
| Rate for Payer: Quartz Beloit One Network |
$145.04
|
| Rate for Payer: Quartz Commercial |
$192.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.73
|
| Rate for Payer: The Alliance Commercial |
$86.92
|
| Rate for Payer: United Healthcare Medicaid |
$22.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare PPO |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: Wellcare Medicare |
$21.73
|
| Rate for Payer: WMAP Medicaid |
$22.45
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Sex Hormone Binding Globulin
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
2943014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$21.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.07
|
| Rate for Payer: Anthem Medicaid |
$22.45
|
| Rate for Payer: Anthem Medicare Advantage |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.73
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Dean Health Medicaid |
$22.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.73
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.73
|
| Rate for Payer: Managed Health Services Medicaid |
$23.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.73
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.60
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.45
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$21.73
|
| Rate for Payer: The Alliance Commercial |
$86.92
|
| Rate for Payer: United Healthcare Medicaid |
$22.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: Wellcare Medicare |
$21.73
|
| Rate for Payer: WMAP Medicaid |
$22.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Sezary Diagnostic Flow Cytometry
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Sezary Diagnostic Flow Cytometry
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Sezary Diagnostic Flow Cytometry
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5364855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.00
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$356.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.00
|
| Rate for Payer: Health EOS Commercial |
$341.25
|
| Rate for Payer: HFN Commercial |
$356.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Preferred Network Access Commercial |
$356.25
|
| Rate for Payer: Quartz Beloit One Network |
$165.00
|
| Rate for Payer: Quartz Commercial |
$213.75
|
| Rate for Payer: The Alliance Commercial |
$187.50
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
Sezary Monitoring Flow Cytometry, Blood
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
6166535
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$337.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$345.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$333.75
|
| Rate for Payer: HFN Commercial |
$345.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$345.00
|
| Rate for Payer: Quartz Beloit One Network |
$183.75
|
| Rate for Payer: Quartz Commercial |
$243.75
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$281.25
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$277.76
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
IP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
SHAVER BLADE 2.0 FULL RADIUS
|
Facility
|
OP
|
$832.00
|
|
| Hospital Charge Code |
3072521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$3,328.00 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.59
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$3,328.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.26
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVER BONE CUTTER 4.0 STR AR-8400BC
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5348952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
OP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.36 |
| Max. Negotiated Rate |
$11,448.00 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Aetna Managed Medicare |
$801.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,860.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,431.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,373.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,601.58
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,146.50
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,860.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,717.20
|
| Rate for Payer: The Alliance Commercial |
$11,448.00
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
SHAVERDRILL FIBER TAK 1.6MM AR-3600NDSR-1
|
Facility
|
IP
|
$2,862.00
|
|
| Hospital Charge Code |
5190725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,402.38 |
| Max. Negotiated Rate |
$2,633.04 |
| Rate for Payer: Aetna Commercial |
$2,575.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,461.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,516.86
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna Commercial |
$2,633.04
|
| Rate for Payer: Health EOS Commercial |
$2,547.18
|
| Rate for Payer: HFN Commercial |
$2,633.04
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,717.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,633.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,402.38
|
| Rate for Payer: Quartz Commercial |
$1,717.20
|
| Rate for Payer: WEA Trust Commercial |
$1,574.10
|
| Rate for Payer: WPS Commercial |
$2,119.88
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$3,700.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.75
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$601.25
|
| Rate for Payer: Quartz Medicare Advantage |
$555.00
|
| Rate for Payer: The Alliance Commercial |
$3,700.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
SHAVER SABRE 2.0MM SMALL JOINT AR-7200SR
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
5307155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.25 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$832.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.25
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$851.00
|
| Rate for Payer: Health EOS Commercial |
$823.25
|
| Rate for Payer: HFN Commercial |
$851.00
|
| Rate for Payer: Multiplan Commercial |
$740.00
|
| Rate for Payer: NAPHCARE Commercial |
$555.00
|
| Rate for Payer: Preferred Network Access Commercial |
$851.00
|
| Rate for Payer: Quartz Beloit One Network |
$453.25
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: WEA Trust Commercial |
$508.75
|
| Rate for Payer: WPS Commercial |
$685.15
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membrane) >2.0cm 11313
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 11313
|
| Hospital Charge Code |
3013535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.81 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: HFN Commercial |
$474.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.18
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: United Healthcare Medicaid |
$112.81
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) <=0.5cm 11310
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
3013532
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$152.88 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.60
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Medicaid |
$51.44
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) 0.6-1.0cm 11311
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
3013533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.34 |
| Max. Negotiated Rate |
$211.02 |
| Rate for Payer: Aetna Commercial |
$181.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$181.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.60
|
| Rate for Payer: Health EOS Commercial |
$173.81
|
| Rate for Payer: HFN Commercial |
$181.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.02
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$181.45
|
| Rate for Payer: Quartz Beloit One Network |
$84.04
|
| Rate for Payer: Quartz Commercial |
$108.87
|
| Rate for Payer: The Alliance Commercial |
$95.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.34
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Shaving of single lesion (face, ears, eyes, nose, lower lips, mucous membranes) 1.1-2.0cm 11312
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 11312
|
| Hospital Charge Code |
3013534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.92
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicaid |
$84.61
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) <=0.5cm 11305
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
3013528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$220.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.20
|
| Rate for Payer: Health EOS Commercial |
$211.12
|
| Rate for Payer: HFN Commercial |
$220.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.56
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$220.40
|
| Rate for Payer: Quartz Beloit One Network |
$102.08
|
| Rate for Payer: Quartz Commercial |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.48
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
