|
ACCESSORY KIT AMS 800 720066-01
|
Facility
|
IP
|
$7,154.00
|
|
| Hospital Charge Code |
5385017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,645.68 |
| Max. Negotiated Rate |
$6,844.95 |
| Rate for Payer: Aetna Commercial |
$6,696.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,398.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,943.28
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: Cigna Commercial |
$6,844.95
|
| Rate for Payer: Health EOS Commercial |
$6,621.74
|
| Rate for Payer: HFN Commercial |
$6,844.95
|
| Rate for Payer: Multiplan Commercial |
$5,952.13
|
| Rate for Payer: Preferred Network Access Commercial |
$6,844.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,645.68
|
| Rate for Payer: Quartz Commercial |
$4,464.10
|
| Rate for Payer: WEA Trust Commercial |
$4,092.09
|
| Rate for Payer: WPS Commercial |
$5,510.73
|
|
|
ACCESSORY KIT TRUCLEAR SUCTION CANISTER (4 JUMPER TUBES/TISSUE SOCK) 7209824
|
Facility
|
IP
|
$483.00
|
|
| Hospital Charge Code |
5563521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$246.14 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$301.39
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
ACCESSORY KIT TRUCLEAR SUCTION CANISTER (4 JUMPER TUBES/TISSUE SOCK) 7209824
|
Facility
|
OP
|
$483.00
|
|
| Hospital Charge Code |
5563521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$140.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.11
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.74
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$301.39
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$326.51
|
| Rate for Payer: Quartz Medicare Advantage |
$301.39
|
| Rate for Payer: The Alliance Commercial |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
ACCESS SPIKE CLAVE MULTIDOSE VIAL 12007
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2963232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
ACCESS SPIKE CLAVE MULTIDOSE VIAL 12007
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2963232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
ACCUMAX 1000 M0068404042
|
Facility
|
OP
|
$5,990.00
|
|
| Hospital Charge Code |
4520036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,744.29 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,744.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,049.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,114.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,990.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,486.18
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,672.20
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: NAPHCARE Commercial |
$3,737.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$4,049.24
|
| Rate for Payer: Quartz Medicare Advantage |
$3,737.76
|
| Rate for Payer: The Alliance Commercial |
$3,114.80
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ACCUMAX 1000 M0068404042
|
Facility
|
IP
|
$5,990.00
|
|
| Hospital Charge Code |
4520036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,052.50 |
| Max. Negotiated Rate |
$5,731.23 |
| Rate for Payer: Aetna Commercial |
$5,606.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,357.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,301.69
|
| Rate for Payer: Cash Price |
$1,797.00
|
| Rate for Payer: Cigna Commercial |
$5,731.23
|
| Rate for Payer: Health EOS Commercial |
$5,544.34
|
| Rate for Payer: HFN Commercial |
$5,731.23
|
| Rate for Payer: Multiplan Commercial |
$4,983.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,731.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.50
|
| Rate for Payer: Quartz Commercial |
$3,737.76
|
| Rate for Payer: WEA Trust Commercial |
$3,426.28
|
| Rate for Payer: WPS Commercial |
$4,614.10
|
|
|
ACCUMAX 365 M0068404022
|
Facility
|
IP
|
$3,603.00
|
|
| Hospital Charge Code |
4520033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,836.09 |
| Max. Negotiated Rate |
$3,447.35 |
| Rate for Payer: Aetna Commercial |
$3,372.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.97
|
| Rate for Payer: Cash Price |
$1,080.90
|
| Rate for Payer: Cigna Commercial |
$3,447.35
|
| Rate for Payer: Health EOS Commercial |
$3,334.94
|
| Rate for Payer: HFN Commercial |
$3,447.35
|
| Rate for Payer: Multiplan Commercial |
$2,997.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.09
|
| Rate for Payer: Quartz Commercial |
$2,248.27
|
| Rate for Payer: WEA Trust Commercial |
$2,060.92
|
| Rate for Payer: WPS Commercial |
$2,775.39
|
|
|
ACCUMAX 365 M0068404022
|
Facility
|
OP
|
$3,603.00
|
|
| Hospital Charge Code |
4520033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.19 |
| Max. Negotiated Rate |
$3,447.35 |
| Rate for Payer: Aetna Commercial |
$3,372.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,222.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,435.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,873.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,798.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.97
|
| Rate for Payer: Cash Price |
$1,080.90
|
| Rate for Payer: Cigna Commercial |
$3,447.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,096.95
|
| Rate for Payer: Health EOS Commercial |
$3,334.94
|
| Rate for Payer: HFN Commercial |
$3,447.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,810.34
|
| Rate for Payer: Multiplan Commercial |
$2,997.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,248.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,447.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.09
|
| Rate for Payer: Quartz Commercial |
$2,435.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,248.27
|
| Rate for Payer: The Alliance Commercial |
$1,873.56
|
| Rate for Payer: WEA Trust Commercial |
$2,060.92
|
| Rate for Payer: WPS Commercial |
$2,775.39
|
|
|
ACCUMAX 550 M0068404032
|
Facility
|
IP
|
$4,750.00
|
|
| Hospital Charge Code |
4520034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,420.60 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
ACCUMAX 550 M0068404032
|
Facility
|
OP
|
$4,750.00
|
|
| Hospital Charge Code |
4520034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,383.20 |
| Max. Negotiated Rate |
$4,544.80 |
| Rate for Payer: Aetna Commercial |
$4,446.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,248.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,383.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,211.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,618.20
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$4,544.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,764.50
|
| Rate for Payer: Health EOS Commercial |
$4,396.60
|
| Rate for Payer: HFN Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,705.00
|
| Rate for Payer: Multiplan Commercial |
$3,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,544.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,420.60
|
| Rate for Payer: Quartz Commercial |
$3,211.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,964.00
|
| Rate for Payer: The Alliance Commercial |
$2,470.00
|
| Rate for Payer: WEA Trust Commercial |
$2,717.00
|
| Rate for Payer: WPS Commercial |
$3,658.93
|
|
|
AccuType IL28B
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
978136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$631.33 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$66.52
|
| Rate for Payer: Anthem Medicare Advantage |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.52
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$631.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.52
|
| Rate for Payer: Health EOS Commercial |
$604.75
|
| Rate for Payer: HFN Commercial |
$631.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$99.78
|
| Rate for Payer: Preferred Network Access Commercial |
$631.33
|
| Rate for Payer: Quartz Beloit One Network |
$292.41
|
| Rate for Payer: Quartz Commercial |
$378.80
|
| Rate for Payer: Quartz Medicare Advantage |
$66.52
|
| Rate for Payer: The Alliance Commercial |
$262.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$292.68
|
|
|
AccuType IL28B
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
978136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$325.63 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$398.74
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
AccuType IL28B
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
978136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$66.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.42
|
| Rate for Payer: Anthem Medicare Advantage |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.52
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66.52
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66.52
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$99.78
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$431.96
|
| Rate for Payer: Quartz Medicare Advantage |
$66.52
|
| Rate for Payer: The Alliance Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.52
|
| Rate for Payer: United Healthcare PPO |
$498.42
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: Wellcare Medicare |
$66.52
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
AccuType IL28B - Interp & Report
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
1270802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
AccuType IL28B - Interp & Report
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
1270802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
AccuType IL28B - Interp & Report
|
Professional
|
Both
|
$115.00
|
|
| Hospital Charge Code |
1270802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
AccuType IL28B - Molecular Diagnostics
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
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
|
|
|
AccuType IL28B - Molecular Diagnostics
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
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
|
|
|
AccuType IL28B - Molecular Diagnostics
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
1270800
|
|
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
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
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
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
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
|
|
|
AccuType IL28B -Molecule Isolate Nucleic
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
1270799
|
|
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
|
|
|
AccuType IL28B - Molecule Nucleic Amplification
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
AccuType IL28B - Molecule Nucleic Amplification
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
1270801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
