|
Sodium Chloride 0.9% IV 500 ML J7040
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
4027269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.34
|
| Rate for Payer: Anthem Medicare Advantage |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.34
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.36
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.01
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1.34
|
| Rate for Payer: The Alliance Commercial |
$3.69
|
| Rate for Payer: United Healthcare Medicaid |
$1.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.34
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$3.39
|
|
|
SODIUM CHLORIDE 0.9% PF 10ML (MED)
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
5923704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
SODIUM CHLORIDE 0.9% PF 10ML (MED)
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
5923704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Sodium hyaluronate 20 mg/mL Soln - Durolane
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
5799848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$6.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.47
|
| Rate for Payer: Anthem Medicare Advantage |
$6.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.78
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.78
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$10.17
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$25.01
|
| Rate for Payer: Quartz Medicare Advantage |
$6.78
|
| Rate for Payer: The Alliance Commercial |
$27.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.78
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: Wellcare Medicare |
$6.78
|
| Rate for Payer: WPS Commercial |
$17.03
|
|
|
Sodium hyaluronate 20 mg/mL Soln - Durolane
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
5799848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$36.56 |
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$6.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.78
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$36.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.81
|
| Rate for Payer: Health EOS Commercial |
$35.02
|
| Rate for Payer: HFN Commercial |
$36.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.78
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$10.17
|
| Rate for Payer: Preferred Network Access Commercial |
$36.56
|
| Rate for Payer: Quartz Beloit One Network |
$16.93
|
| Rate for Payer: Quartz Commercial |
$21.93
|
| Rate for Payer: Quartz Medicare Advantage |
$6.78
|
| Rate for Payer: The Alliance Commercial |
$18.65
|
| Rate for Payer: United Healthcare Medicaid |
$6.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.78
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$17.03
|
|
|
Sodium hyaluronate 20 mg/mL Soln - Durolane
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
5799848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
Sodium Level
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.00
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.00
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$7.50
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$5.00
|
| Rate for Payer: The Alliance Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.00
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$5.00
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Sodium Level
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Sodium Level
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
633611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.00
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.00
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$7.50
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$5.00
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.00
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$22.01
|
|
|
Sodium Level 24 Hour Urine
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: Aetna Commercial |
$65.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$65.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$62.46
|
| Rate for Payer: HFN Commercial |
$65.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$65.21
|
| Rate for Payer: Quartz Beloit One Network |
$30.20
|
| Rate for Payer: Quartz Commercial |
$39.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$20.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$23.15
|
|
|
Sodium Level 24 Hour Urine
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Sodium Level 24 Hour Urine
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$21.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: United Healthcare PPO |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: Wellcare Medicare |
$5.26
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Sodium Level Stool
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$5.05
|
| Rate for Payer: Anthem Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.05
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.05
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$7.58
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$5.05
|
| Rate for Payer: The Alliance Commercial |
$19.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.05
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$22.24
|
|
|
Sodium Level Stool
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Sodium Level Stool
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
978070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$5.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.05
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.05
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$7.58
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$5.05
|
| Rate for Payer: The Alliance Commercial |
$20.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.05
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$5.05
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Sodium Level Urine
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$21.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: United Healthcare PPO |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$5.26
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Sodium Level Urine
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Sodium Level Urine
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
633612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$20.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$23.15
|
|
|
Sodium Tetradecyl 1% 2ml vial [Med]
|
Facility
|
IP
|
$931.00
|
|
| Hospital Charge Code |
2974982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.44 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$580.94
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
Sodium Tetradecyl 1% 2ml vial [Med]
|
Facility
|
OP
|
$931.00
|
|
| Hospital Charge Code |
2974982
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$890.78 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Aetna Managed Medicare |
$271.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$629.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$484.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.17
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$890.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$541.84
|
| Rate for Payer: Health EOS Commercial |
$861.73
|
| Rate for Payer: HFN Commercial |
$890.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.18
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: NAPHCARE Commercial |
$580.94
|
| Rate for Payer: Preferred Network Access Commercial |
$890.78
|
| Rate for Payer: Quartz Beloit One Network |
$474.44
|
| Rate for Payer: Quartz Commercial |
$629.36
|
| Rate for Payer: Quartz Medicare Advantage |
$580.94
|
| Rate for Payer: The Alliance Commercial |
$484.12
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLACK/BLUE) #2 SUTURE (BLUE/BLACK) AR
|
Facility
|
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.37 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,668.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,052.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,970.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,297.15
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,078.66
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,462.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,668.17
|
| Rate for Payer: Quartz Medicare Advantage |
$2,462.93
|
| Rate for Payer: The Alliance Commercial |
$2,052.44
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLACK/BLUE) #2 SUTURE (BLUE/BLACK) AR
|
Facility
|
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.39 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,462.93
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLUE) #2 SUTURE (WHITE/BLACK) AR-3653
|
Facility
|
IP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.39 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,462.93
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
SOFT ANCHOR FIBERTAK 2.6MM KNOTLESS RC SP 1.7 FIBER TAPE LOOP (BLUE) #2 SUTURE (WHITE/BLACK) AR-3653
|
Facility
|
OP
|
$3,947.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6174118
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.37 |
| Max. Negotiated Rate |
$3,776.49 |
| Rate for Payer: Aetna Commercial |
$3,694.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,530.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,668.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,052.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,970.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,175.59
|
| Rate for Payer: Cash Price |
$1,184.10
|
| Rate for Payer: Cigna Commercial |
$3,776.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,297.15
|
| Rate for Payer: Health EOS Commercial |
$3,653.34
|
| Rate for Payer: HFN Commercial |
$3,776.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,078.66
|
| Rate for Payer: Multiplan Commercial |
$3,283.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,462.93
|
| Rate for Payer: Preferred Network Access Commercial |
$3,776.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.39
|
| Rate for Payer: Quartz Commercial |
$2,668.17
|
| Rate for Payer: Quartz Medicare Advantage |
$2,462.93
|
| Rate for Payer: The Alliance Commercial |
$2,052.44
|
| Rate for Payer: WEA Trust Commercial |
$2,257.68
|
| Rate for Payer: WPS Commercial |
$3,040.37
|
|
|
Soft Interface below Knee Se L2820
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS L2820
|
| Hospital Charge Code |
4718607
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.78 |
| Max. Negotiated Rate |
$299.24 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$103.78
|
| Rate for Payer: Anthem Medicare Advantage |
$103.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.78
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.78
|
| Rate for Payer: Health EOS Commercial |
$238.49
|
| Rate for Payer: HFN Commercial |
$248.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.78
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$155.67
|
| Rate for Payer: Preferred Network Access Commercial |
$248.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.32
|
| Rate for Payer: Quartz Commercial |
$149.39
|
| Rate for Payer: Quartz Medicare Advantage |
$103.78
|
| Rate for Payer: The Alliance Commercial |
$285.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.78
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$181.62
|
|
