|
Bisphenol A and Creatinine, Random Urine
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3624168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.40
|
| Rate for Payer: Health EOS Commercial |
$131.04
|
| Rate for Payer: HFN Commercial |
$136.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.11
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$136.80
|
| Rate for Payer: Quartz Beloit One Network |
$63.36
|
| Rate for Payer: Quartz Commercial |
$82.08
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$345.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.52
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$353.28
|
| Rate for Payer: Health EOS Commercial |
$341.76
|
| Rate for Payer: HFN Commercial |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: NAPHCARE Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$353.28
|
| Rate for Payer: Quartz Beloit One Network |
$188.16
|
| Rate for Payer: Quartz Commercial |
$230.40
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$345.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$353.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$341.76
|
| Rate for Payer: HFN Commercial |
$353.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$353.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$188.16
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$364.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.40
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: HFN Commercial |
$364.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$364.80
|
| Rate for Payer: Quartz Beloit One Network |
$168.96
|
| Rate for Payer: Quartz Commercial |
$218.88
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
BK Virus DNA, Qualitative PCR
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
BK Virus DNA, Qualitative PCR
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna Commercial |
$233.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$233.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.60
|
| Rate for Payer: Health EOS Commercial |
$223.86
|
| Rate for Payer: HFN Commercial |
$233.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$233.70
|
| Rate for Payer: Quartz Beloit One Network |
$108.24
|
| Rate for Payer: Quartz Commercial |
$140.22
|
| Rate for Payer: The Alliance Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
BK Virus DNA, Qualitative PCR
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.66
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$184.50
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
BK Virus DNA, Quantitative, PCR
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: HFN Commercial |
$571.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BK Virus DNA, Quantitative, PCR
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BK Virus DNA, Quantitative, PCR
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$451.50
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$444.36 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.29
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$313.95
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$362.25
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.67 |
| Max. Negotiated Rate |
$444.36 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$289.80
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$289.80
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$458.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$458.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$439.53
|
| Rate for Payer: HFN Commercial |
$458.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Preferred Network Access Commercial |
$458.85
|
| Rate for Payer: Quartz Beloit One Network |
$212.52
|
| Rate for Payer: Quartz Commercial |
$275.31
|
| Rate for Payer: The Alliance Commercial |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
BLADDER CALCULUS REMOVAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959846
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BLADDER CALCULUS REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959846
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BLADDER DILATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959847
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BLADDER DILATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959847
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Bladder Instillation of Anticarcinogenic Agent 51720
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
1188983
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.60
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: HFN Commercial |
$570.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$145.61
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: The Alliance Commercial |
$300.50
|
| Rate for Payer: United Healthcare Medicaid |
$33.63
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$675.19 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$2,700.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
|
|
Bladder Irrigation, lavage 51700
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
1188984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.56
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.50
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,742.62 |
| Max. Negotiated Rate |
$7,026.96 |
| Rate for Payer: Aetna Commercial |
$6,874.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,568.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,048.14
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,026.96
|
| Rate for Payer: Health EOS Commercial |
$6,797.82
|
| Rate for Payer: HFN Commercial |
$7,026.96
|
| Rate for Payer: Multiplan Commercial |
$6,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,026.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,742.62
|
| Rate for Payer: Quartz Commercial |
$4,582.80
|
| Rate for Payer: WEA Trust Commercial |
$4,200.90
|
| Rate for Payer: WPS Commercial |
$5,657.47
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
|
OP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,138.64 |
| Max. Negotiated Rate |
$30,552.00 |
| Rate for Payer: Aetna Commercial |
$6,874.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,568.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,138.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,964.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,666.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,048.14
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,026.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,274.22
|
| Rate for Payer: Health EOS Commercial |
$6,797.82
|
| Rate for Payer: HFN Commercial |
$7,026.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,728.50
|
| Rate for Payer: Multiplan Commercial |
$6,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,582.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,026.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,742.62
|
| Rate for Payer: Quartz Commercial |
$4,964.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,582.80
|
| Rate for Payer: The Alliance Commercial |
$30,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,200.90
|
| Rate for Payer: WPS Commercial |
$5,657.47
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
|
OP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,059.40 |
| Max. Negotiated Rate |
$29,420.00 |
| Rate for Payer: Aetna Commercial |
$6,619.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,325.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,059.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,780.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,677.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,530.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,898.15
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$6,766.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,115.86
|
| Rate for Payer: Health EOS Commercial |
$6,545.95
|
| Rate for Payer: HFN Commercial |
$6,766.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,516.25
|
| Rate for Payer: Multiplan Commercial |
$5,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,766.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,603.95
|
| Rate for Payer: Quartz Commercial |
$4,780.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,413.00
|
| Rate for Payer: The Alliance Commercial |
$29,420.00
|
| Rate for Payer: WEA Trust Commercial |
$4,045.25
|
| Rate for Payer: WPS Commercial |
$5,447.85
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
|
IP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,603.95 |
| Max. Negotiated Rate |
$6,766.60 |
| Rate for Payer: Aetna Commercial |
$6,619.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,325.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,898.15
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$6,766.60
|
| Rate for Payer: Health EOS Commercial |
$6,545.95
|
| Rate for Payer: HFN Commercial |
$6,766.60
|
| Rate for Payer: Multiplan Commercial |
$5,884.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,413.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,766.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,603.95
|
| Rate for Payer: Quartz Commercial |
$4,413.00
|
| Rate for Payer: WEA Trust Commercial |
$4,045.25
|
| Rate for Payer: WPS Commercial |
$5,447.85
|
|
|
BLADDER SLING LYNX MIDURETHRAL 850-300
|
Facility
|
IP
|
$6,618.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2964826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,242.82 |
| Max. Negotiated Rate |
$6,088.56 |
| Rate for Payer: Aetna Commercial |
$5,956.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,691.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,507.54
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$6,088.56
|
| Rate for Payer: Health EOS Commercial |
$5,890.02
|
| Rate for Payer: HFN Commercial |
$6,088.56
|
| Rate for Payer: Multiplan Commercial |
$5,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,970.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,088.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,242.82
|
| Rate for Payer: Quartz Commercial |
$3,970.80
|
| Rate for Payer: WEA Trust Commercial |
$3,639.90
|
| Rate for Payer: WPS Commercial |
$4,901.95
|
|
