|
BCG 1 Unit Charge
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
2958944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$392.39 |
| Max. Negotiated Rate |
$736.74 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.42
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$736.74
|
| Rate for Payer: Health EOS Commercial |
$712.71
|
| Rate for Payer: HFN Commercial |
$736.74
|
| Rate for Payer: Multiplan Commercial |
$640.64
|
| Rate for Payer: Preferred Network Access Commercial |
$736.74
|
| Rate for Payer: Quartz Beloit One Network |
$392.39
|
| Rate for Payer: Quartz Commercial |
$480.48
|
| Rate for Payer: WEA Trust Commercial |
$440.44
|
| Rate for Payer: WPS Commercial |
$593.13
|
|
|
Bcg live intravesical vac J9030
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
5528774
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
Bcg live intravesical vac J9030
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
5528774
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$3.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.41
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.41
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.41
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$5.12
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$3.41
|
| Rate for Payer: The Alliance Commercial |
$13.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.41
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$3.41
|
| Rate for Payer: WPS Commercial |
$7.51
|
|
|
Bcg live intravesical vac J9030
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
5528774
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$363.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$3.41
|
| Rate for Payer: Anthem Medicare Advantage |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.41
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$363.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.01
|
| Rate for Payer: Health EOS Commercial |
$348.28
|
| Rate for Payer: HFN Commercial |
$363.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.41
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$5.12
|
| Rate for Payer: Preferred Network Access Commercial |
$363.58
|
| Rate for Payer: Quartz Beloit One Network |
$168.40
|
| Rate for Payer: Quartz Commercial |
$218.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.41
|
| Rate for Payer: The Alliance Commercial |
$9.38
|
| Rate for Payer: United Healthcare Medicaid |
$3.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.41
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$7.51
|
|
|
BCR-ABL 1 / 91065
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
5313604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$682.07 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$170.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$639.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.06
|
| Rate for Payer: Anthem Medicare Advantage |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.52
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$170.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$170.52
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$170.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$170.52
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$255.78
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$170.52
|
| Rate for Payer: The Alliance Commercial |
$682.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.52
|
| Rate for Payer: United Healthcare PPO |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: Wellcare Medicare |
$170.52
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
BCR-ABL 1 / 91065
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
5313604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$750.28 |
| Rate for Payer: Aetna Commercial |
$187.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$170.52
|
| Rate for Payer: Anthem Medicare Advantage |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.52
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$187.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.52
|
| Rate for Payer: Health EOS Commercial |
$179.82
|
| Rate for Payer: HFN Commercial |
$187.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$601.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$601.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.52
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$255.78
|
| Rate for Payer: Preferred Network Access Commercial |
$187.72
|
| Rate for Payer: Quartz Beloit One Network |
$86.94
|
| Rate for Payer: Quartz Commercial |
$112.63
|
| Rate for Payer: Quartz Medicare Advantage |
$170.52
|
| Rate for Payer: The Alliance Commercial |
$673.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.52
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$750.28
|
|
|
BCR-ABL 1 / 91065
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 81206
|
| Hospital Charge Code |
5313604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
BCR ABL1/ABL1%(IS)
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
5313656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$662.79 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$150.63
|
| Rate for Payer: Anthem Medicare Advantage |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.63
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$531.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.63
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$225.95
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$150.63
|
| Rate for Payer: The Alliance Commercial |
$595.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.63
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$662.79
|
|
|
BCR ABL1/ABL1%(IS)
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
5313656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$602.53 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$150.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.05
|
| Rate for Payer: Anthem Medicare Advantage |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.63
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.63
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$225.95
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$150.63
|
| Rate for Payer: The Alliance Commercial |
$602.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.63
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$150.63
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
BCR ABL1/ABL1%(IS)
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 81207
|
| Hospital Charge Code |
5313656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
BCR/ABL Amplification
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
2788814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
BCR/ABL Amplification
|
Professional
|
Both
|
$116.00
|
|
| Hospital Charge Code |
2788814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.38
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
BCR/ABL Amplification
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
2788814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$33.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.48
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$72.38
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
BCR/ABL Extraction
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
2790799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
BCR/ABL Extraction
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
2790799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: United Healthcare PPO |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
BCR/ABL Extraction
|
Professional
|
Both
|
$46.00
|
|
| Hospital Charge Code |
2790799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
BCR/ABL Interp & Report
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
2790800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$16.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$34.94
|
| Rate for Payer: The Alliance Commercial |
$29.12
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
BCR/ABL Interp & Report
|
Professional
|
Both
|
$56.00
|
|
| Hospital Charge Code |
2790800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.94
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: The Alliance Commercial |
$29.12
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
BCR/ABL Interp & Report
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
2790800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
BCR/ABL Nucleic Acid Probe
|
Professional
|
Both
|
$54.00
|
|
| Hospital Charge Code |
2790801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.70
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
BCR/ABL Nucleic Acid Probe
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
2790801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
BCR/ABL Nucleic Acid Probe
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
2790801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
BCR/ABL Reverse Transcription
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
BCR/ABL Reverse Transcription
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
BCR/ABL Reverse Transcription
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2790805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
