|
SOL RX ISOLYTE MCGAQ S 1000ML
|
Facility
|
IP
|
$685.00
|
|
| Hospital Charge Code |
2974480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.08 |
| Max. Negotiated Rate |
$655.41 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.57
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$655.41
|
| Rate for Payer: Health EOS Commercial |
$634.04
|
| Rate for Payer: HFN Commercial |
$655.41
|
| Rate for Payer: Multiplan Commercial |
$569.92
|
| Rate for Payer: Preferred Network Access Commercial |
$655.41
|
| Rate for Payer: Quartz Beloit One Network |
$349.08
|
| Rate for Payer: Quartz Commercial |
$427.44
|
| Rate for Payer: WEA Trust Commercial |
$391.82
|
| Rate for Payer: WPS Commercial |
$527.66
|
|
|
SOL STERILE H20 PB 500ML
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2971279
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
SOL STERILE H20 PB 500ML
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2971279
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
SOL STERILE WATER 1500 7139-36
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2970861
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$19.22 |
| 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 |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| 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: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| 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 |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
SOL STERILE WATER 1500 7139-36
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2970861
|
|
Hospital Revenue Code
|
258
|
| 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
|
|
|
SOL STERILE WATER IRR 3000ML 0990-7973-08
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
4494352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
SOL STERILE WATER IRR 3000ML 0990-7973-08
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
4494352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
SOL STERILE WATER PB 250ML 6139-22
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
5248650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
SOL STERILE WATER PB 250ML 6139-22
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
5248650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$58.76
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Soluble Liver Antigen (SLA) Autoantibody
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3473526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$203.53 |
| Rate for Payer: Aetna Commercial |
$203.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$203.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$194.96
|
| Rate for Payer: HFN Commercial |
$203.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$203.53
|
| Rate for Payer: Quartz Beloit One Network |
$94.27
|
| Rate for Payer: Quartz Commercial |
$122.12
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Soluble Liver Antigen (SLA) Autoantibody
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3473526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$197.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$190.67
|
| Rate for Payer: HFN Commercial |
$197.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$197.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.98
|
| Rate for Payer: Quartz Commercial |
$139.26
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$160.68
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$158.68
|
|
|
Soluble Liver Antigen (SLA) Autoantibody
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3473526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.55
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$197.10
|
| Rate for Payer: Health EOS Commercial |
$190.67
|
| Rate for Payer: HFN Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: Preferred Network Access Commercial |
$197.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.98
|
| Rate for Payer: Quartz Commercial |
$128.54
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: WPS Commercial |
$158.68
|
|
|
Soluble Transferrin Receptor Level
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
978133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$38.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$142.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.13
|
| Rate for Payer: Anthem Medicare Advantage |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.03
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.03
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$57.05
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$220.38
|
| Rate for Payer: Quartz Medicare Advantage |
$38.03
|
| Rate for Payer: The Alliance Commercial |
$152.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.03
|
| Rate for Payer: United Healthcare PPO |
$254.28
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: Wellcare Medicare |
$38.03
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Soluble Transferrin Receptor Level
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
978133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.13 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$203.42
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Soluble Transferrin Receptor Level
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
978133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$322.09 |
| Rate for Payer: Aetna Commercial |
$322.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$38.03
|
| Rate for Payer: Anthem Medicare Advantage |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.03
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$322.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.03
|
| Rate for Payer: Health EOS Commercial |
$308.53
|
| Rate for Payer: HFN Commercial |
$322.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.03
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$57.05
|
| Rate for Payer: Preferred Network Access Commercial |
$322.09
|
| Rate for Payer: Quartz Beloit One Network |
$149.18
|
| Rate for Payer: Quartz Commercial |
$193.25
|
| Rate for Payer: Quartz Medicare Advantage |
$38.03
|
| Rate for Payer: The Alliance Commercial |
$150.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.03
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$167.34
|
|
|
Solu-Medrol 125 mg Charge
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
Solu-Medrol 125 mg Charge
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
Solu-Medrol 125 mg Charge
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
3002796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$25.55
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.79
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$12.36
|
| Rate for Payer: Quartz Commercial |
$16.01
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.21
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$20.59
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$22.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.59
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$20.59
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
Solu-Medrol Injection 40 mg Charge
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J2920
|
| Hospital Charge Code |
3002801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$32.60 |
| Rate for Payer: Aetna Commercial |
$32.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$32.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.59
|
| Rate for Payer: Health EOS Commercial |
$31.23
|
| Rate for Payer: HFN Commercial |
$32.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.50
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$32.60
|
| Rate for Payer: Quartz Beloit One Network |
$15.10
|
| Rate for Payer: Quartz Commercial |
$19.56
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
Solution 1000 SOD CHL
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040286
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Solution 1000 SOD CHL
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040286
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Solution 500 Sod Chl
|
Facility
|
OP
|
$40.00
|
|
| Hospital Charge Code |
3101785
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.96
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Solution 500 Sod Chl
|
Facility
|
IP
|
$40.00
|
|
| Hospital Charge Code |
3101785
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
