|
Blastomyces Antibody ID
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Blastomyces Antibody ID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$51.60 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$51.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.98
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$157.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$182.25
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$230.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.80
|
| Rate for Payer: Health EOS Commercial |
$221.13
|
| Rate for Payer: HFN Commercial |
$230.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$230.85
|
| Rate for Payer: Quartz Beloit One Network |
$106.92
|
| Rate for Payer: Quartz Commercial |
$138.51
|
| Rate for Payer: The Alliance Commercial |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$145.80
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
BL DRAW UNDER 3 YRS FEM/JUGULAR 36400
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
3014520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.80
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.49
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: United Healthcare Medicaid |
$34.21
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
BL DRAW UNDER 3 YRS OTHER VEIN 36406
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3014522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.51
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
|
IP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$313.20
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
|
OP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Aetna Managed Medicare |
$146.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.11
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.50
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$339.30
|
| Rate for Payer: Quartz Medicare Advantage |
$313.20
|
| Rate for Payer: The Alliance Commercial |
$2,088.00
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
Blenoxane 15 units Charge
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
Blenoxane 15 units Charge
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.59
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$57.80
|
|
|
Blenoxane 15 units Charge
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$256.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.12
|
| Rate for Payer: Health EOS Commercial |
$245.70
|
| Rate for Payer: HFN Commercial |
$256.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$256.50
|
| Rate for Payer: Quartz Beloit One Network |
$118.80
|
| Rate for Payer: Quartz Commercial |
$153.90
|
| Rate for Payer: The Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$57.80
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
Blepharoplasty With Excessive Skin Weighting Down Lid
|
Professional
|
Both
|
$2,495.00
|
|
|
Service Code
|
CPT 15823
|
| Hospital Charge Code |
1188911
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$554.68 |
| Max. Negotiated Rate |
$2,370.25 |
| Rate for Payer: Aetna Commercial |
$2,370.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,145.70
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cigna Commercial |
$2,370.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$554.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,497.00
|
| Rate for Payer: Health EOS Commercial |
$2,270.45
|
| Rate for Payer: HFN Commercial |
$2,370.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,858.16
|
| Rate for Payer: Multiplan Commercial |
$1,996.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.80
|
| Rate for Payer: Quartz Commercial |
$1,422.15
|
| Rate for Payer: The Alliance Commercial |
$1,247.50
|
| Rate for Payer: United Healthcare Medicaid |
$554.68
|
| Rate for Payer: WEA Trust Commercial |
$1,372.25
|
| Rate for Payer: WPS Commercial |
$1,848.05
|
|
|
BLEPHAROTOMY DRAINAGE ABSCESS EYELID, BILAT 6770050
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
CPT 67700 50
|
| Hospital Charge Code |
6182083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$751.45 |
| Rate for Payer: Aetna Commercial |
$751.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$680.26
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$751.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.60
|
| Rate for Payer: Health EOS Commercial |
$719.81
|
| Rate for Payer: HFN Commercial |
$751.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.96
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Preferred Network Access Commercial |
$751.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.04
|
| Rate for Payer: Quartz Commercial |
$450.87
|
| Rate for Payer: The Alliance Commercial |
$395.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$435.05
|
| Rate for Payer: WPS Commercial |
$585.89
|
|
|
Blepharotomy, Drainage Of Abscess Eyelid
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
1190828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$389.96 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.96
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
BLOCK BITE RETENT STRAP ENDOGUARD 48FR 69100
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2974696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
BLOCK BITE RETENT STRAP ENDOGUARD 48FR 69100
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2974696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
BLOCK, CAUDAL
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK, CAUDAL
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK CELIAC PLEXUS
|
Facility
|
OP
|
$2,332.00
|
|
| Hospital Charge Code |
5262688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.96 |
| Max. Negotiated Rate |
$9,328.00 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.52
|
| Rate for Payer: Aetna Managed Medicare |
$652.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,515.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.99
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,515.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.20
|
| Rate for Payer: The Alliance Commercial |
$9,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
