|
AXILLARY BLOCK - SET-UP CHARGE
|
Facility
|
IP
|
$1,325.00
|
|
| Hospital Charge Code |
4519589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$675.22 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
AXILLARY BLOCK - SET-UP CHARGE
|
Facility
|
OP
|
$1,325.00
|
|
| Hospital Charge Code |
4519589
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$1,267.76 |
| Rate for Payer: Aetna Commercial |
$1,240.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.08
|
| Rate for Payer: Aetna Managed Medicare |
$385.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$895.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.34
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,267.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.15
|
| Rate for Payer: Health EOS Commercial |
$1,226.42
|
| Rate for Payer: HFN Commercial |
$1,267.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$1,102.40
|
| Rate for Payer: NAPHCARE Commercial |
$826.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.76
|
| Rate for Payer: Quartz Beloit One Network |
$675.22
|
| Rate for Payer: Quartz Commercial |
$895.70
|
| Rate for Payer: Quartz Medicare Advantage |
$826.80
|
| Rate for Payer: The Alliance Commercial |
$689.00
|
| Rate for Payer: WEA Trust Commercial |
$757.90
|
| Rate for Payer: WPS Commercial |
$1,020.65
|
|
|
AXILLARY LYMPH NODE DISSECTION
|
Facility
|
OP
|
$1,090.00
|
|
| Hospital Charge Code |
2959839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.41 |
| Max. Negotiated Rate |
$1,042.91 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.90
|
| Rate for Payer: Aetna Managed Medicare |
$317.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$736.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.81
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$1,042.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$634.38
|
| Rate for Payer: Health EOS Commercial |
$1,008.90
|
| Rate for Payer: HFN Commercial |
$1,042.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$850.20
|
| Rate for Payer: Multiplan Commercial |
$906.88
|
| Rate for Payer: NAPHCARE Commercial |
$680.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.91
|
| Rate for Payer: Quartz Beloit One Network |
$555.46
|
| Rate for Payer: Quartz Commercial |
$736.84
|
| Rate for Payer: Quartz Medicare Advantage |
$680.16
|
| Rate for Payer: The Alliance Commercial |
$566.80
|
| Rate for Payer: WEA Trust Commercial |
$623.48
|
| Rate for Payer: WPS Commercial |
$839.63
|
|
|
AXILLARY LYMPH NODE DISSECTION
|
Facility
|
IP
|
$1,090.00
|
|
| Hospital Charge Code |
2959839
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$555.46 |
| Max. Negotiated Rate |
$1,042.91 |
| Rate for Payer: Aetna Commercial |
$1,020.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.81
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna Commercial |
$1,042.91
|
| Rate for Payer: Health EOS Commercial |
$1,008.90
|
| Rate for Payer: HFN Commercial |
$1,042.91
|
| Rate for Payer: Multiplan Commercial |
$906.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.91
|
| Rate for Payer: Quartz Beloit One Network |
$555.46
|
| Rate for Payer: Quartz Commercial |
$680.16
|
| Rate for Payer: WEA Trust Commercial |
$623.48
|
| Rate for Payer: WPS Commercial |
$839.63
|
|
|
AXILLO FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2959837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,527.58 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Aetna Managed Medicare |
$4,527.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,510.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,084.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,761.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,048.94
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,127.44
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: NAPHCARE Commercial |
$9,701.95
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$10,510.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,701.95
|
| Rate for Payer: The Alliance Commercial |
$8,084.96
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
AXILLO FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2959837
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,923.26 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$9,701.95
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
AXILLO FEMORAL FEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$15,548.00
|
|
| Hospital Charge Code |
2959838
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,527.58 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Aetna Managed Medicare |
$4,527.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,510.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,084.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,761.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,048.94
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,127.44
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: NAPHCARE Commercial |
$9,701.95
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$10,510.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,701.95
|
| Rate for Payer: The Alliance Commercial |
$8,084.96
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
AXILLO FEMORAL FEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$15,548.00
|
|
| Hospital Charge Code |
2959838
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,923.26 |
| Max. Negotiated Rate |
$14,876.33 |
| Rate for Payer: Aetna Commercial |
$14,552.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,906.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,570.06
|
| Rate for Payer: Cash Price |
$4,664.40
|
| Rate for Payer: Cigna Commercial |
$14,876.33
|
| Rate for Payer: Health EOS Commercial |
$14,391.23
|
| Rate for Payer: HFN Commercial |
$14,876.33
|
| Rate for Payer: Multiplan Commercial |
$12,935.94
|
| Rate for Payer: Preferred Network Access Commercial |
$14,876.33
|
| Rate for Payer: Quartz Beloit One Network |
$7,923.26
|
| Rate for Payer: Quartz Commercial |
$9,701.95
|
| Rate for Payer: WEA Trust Commercial |
$8,893.46
|
| Rate for Payer: WPS Commercial |
$11,976.62
|
|
|
Axumin
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$1,340.64 |
| Rate for Payer: Aetna Commercial |
$1,067.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.51
|
| Rate for Payer: Aetna Managed Medicare |
$335.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$771.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$593.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$569.59
|
| Rate for Payer: Anthem Medicare Advantage |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.16
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,091.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$335.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$335.16
|
| Rate for Payer: Health EOS Commercial |
$1,056.11
|
| Rate for Payer: HFN Commercial |
$1,091.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,246.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$335.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$335.16
|
| Rate for Payer: Multiplan Commercial |
$949.31
|
| Rate for Payer: NAPHCARE Commercial |
$502.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.71
|
| Rate for Payer: Quartz Beloit One Network |
$581.45
|
| Rate for Payer: Quartz Commercial |
$771.32
|
| Rate for Payer: Quartz Medicare Advantage |
$335.16
|
| Rate for Payer: The Alliance Commercial |
$1,340.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.16
|
| Rate for Payer: WEA Trust Commercial |
$652.65
|
| Rate for Payer: Wellcare Medicare |
$335.16
|
| Rate for Payer: WPS Commercial |
$878.91
|
|
|
Axumin
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$522.12 |
| Max. Negotiated Rate |
$1,127.31 |
| Rate for Payer: Aetna Commercial |
$1,127.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.51
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,127.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$593.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$711.98
|
| Rate for Payer: Health EOS Commercial |
$1,079.84
|
| Rate for Payer: HFN Commercial |
$1,127.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.75
|
| Rate for Payer: Multiplan Commercial |
$949.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.31
|
| Rate for Payer: Quartz Beloit One Network |
$522.12
|
| Rate for Payer: Quartz Commercial |
$676.38
|
| Rate for Payer: The Alliance Commercial |
$593.32
|
| Rate for Payer: WEA Trust Commercial |
$652.65
|
| Rate for Payer: WPS Commercial |
$878.91
|
|
|
Axumin
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5422637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$581.45 |
| Max. Negotiated Rate |
$1,091.71 |
| Rate for Payer: Aetna Commercial |
$1,067.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,020.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.92
|
| Rate for Payer: Cash Price |
$342.30
|
| Rate for Payer: Cigna Commercial |
$1,091.71
|
| Rate for Payer: Health EOS Commercial |
$1,056.11
|
| Rate for Payer: HFN Commercial |
$1,091.71
|
| Rate for Payer: Multiplan Commercial |
$949.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,091.71
|
| Rate for Payer: Quartz Beloit One Network |
$581.45
|
| Rate for Payer: Quartz Commercial |
$711.98
|
| Rate for Payer: WEA Trust Commercial |
$652.65
|
| Rate for Payer: WPS Commercial |
$878.91
|
|
|
Azithromycin 500mg vial [Med]
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
2975000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.31
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.94
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$45.55
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$45.55
|
| Rate for Payer: The Alliance Commercial |
$8.49
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$6.26
|
|
|
Azithromycin 500mg vial [Med]
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS J0456
|
| Hospital Charge Code |
2975000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$104.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
B2 Glycoprotein 1 Antibody IgA
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.94
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.94
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$104.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
B2 Glycoprotein 1 Antibody IgG
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
B2 Glycoprotein 1 Antibody IgM
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
B2 Glycoprotein 1 Antibody IgM
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$104.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
B2 Glycoprotein 1 Antibody IgM
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.94
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
BABCOCK ENDO 10MM 10BB
|
Facility
|
OP
|
$1,296.00
|
|
| Hospital Charge Code |
3633522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Aetna Managed Medicare |
$377.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$673.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$646.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.27
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,010.88
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: NAPHCARE Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$876.10
|
| Rate for Payer: Quartz Medicare Advantage |
$808.70
|
| Rate for Payer: The Alliance Commercial |
$673.92
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
BABCOCK ENDO 10MM 10BB
|
Facility
|
IP
|
$1,296.00
|
|
| Hospital Charge Code |
3633522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$1,240.01 |
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.36
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,240.01
|
| Rate for Payer: Health EOS Commercial |
$1,199.58
|
| Rate for Payer: HFN Commercial |
$1,240.01
|
| Rate for Payer: Multiplan Commercial |
$1,078.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.01
|
| Rate for Payer: Quartz Beloit One Network |
$660.44
|
| Rate for Payer: Quartz Commercial |
$808.70
|
| Rate for Payer: WEA Trust Commercial |
$741.31
|
| Rate for Payer: WPS Commercial |
$998.31
|
|
|
BABCOCK ENDO 10MM CLAMP 174001
|
Facility
|
OP
|
$1,762.00
|
|
| Hospital Charge Code |
2962917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.09 |
| Max. Negotiated Rate |
$1,685.88 |
| Rate for Payer: Aetna Commercial |
$1,649.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.93
|
| Rate for Payer: Aetna Managed Medicare |
$513.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,191.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$879.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.21
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,685.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.48
|
| Rate for Payer: Health EOS Commercial |
$1,630.91
|
| Rate for Payer: HFN Commercial |
$1,685.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,374.36
|
| Rate for Payer: Multiplan Commercial |
$1,465.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.88
|
| Rate for Payer: Quartz Beloit One Network |
$897.92
|
| Rate for Payer: Quartz Commercial |
$1,191.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,099.49
|
| Rate for Payer: The Alliance Commercial |
$916.24
|
| Rate for Payer: WEA Trust Commercial |
$1,007.86
|
| Rate for Payer: WPS Commercial |
$1,357.27
|
|
