|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0448
|
Facility
IP
|
$3,018.00
|
|
| Hospital Charge Code |
5611694
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,478.82 |
| Max. Negotiated Rate |
$2,776.56 |
| Rate for Payer: Aetna Commercial |
$2,716.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.54
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,776.56
|
| Rate for Payer: Health EOS Commercial |
$2,686.02
|
| Rate for Payer: HFN Commercial |
$2,776.56
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.82
|
| Rate for Payer: Quartz Commercial |
$1,810.80
|
| Rate for Payer: WEA Trust Commercial |
$1,659.90
|
| Rate for Payer: WPS Commercial |
$2,235.43
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0448
|
Facility
OP
|
$3,018.00
|
|
| Hospital Charge Code |
5611694
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$845.04 |
| Max. Negotiated Rate |
$12,072.00 |
| Rate for Payer: Aetna Commercial |
$2,716.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,595.48
|
| Rate for Payer: Aetna Managed Medicare |
$845.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,509.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.54
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,776.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.87
|
| Rate for Payer: Health EOS Commercial |
$2,686.02
|
| Rate for Payer: HFN Commercial |
$2,776.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,263.50
|
| Rate for Payer: Multiplan Commercial |
$2,414.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.82
|
| Rate for Payer: Quartz Commercial |
$1,961.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.80
|
| Rate for Payer: The Alliance Commercial |
$12,072.00
|
| Rate for Payer: WEA Trust Commercial |
$1,659.90
|
| Rate for Payer: WPS Commercial |
$2,235.43
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.0MM SINGLE-USE 0570-0449
|
Facility
IP
|
$3,265.00
|
|
| Hospital Charge Code |
5459378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,599.85 |
| Max. Negotiated Rate |
$3,003.80 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$1,959.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.0MM SINGLE-USE 0570-0449
|
Facility
OP
|
$3,265.00
|
|
| Hospital Charge Code |
5459378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$914.20 |
| Max. Negotiated Rate |
$13,060.00 |
| Rate for Payer: Aetna Commercial |
$2,938.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,807.90
|
| Rate for Payer: Aetna Managed Medicare |
$914.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,122.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,567.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,730.45
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,003.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,827.09
|
| Rate for Payer: Health EOS Commercial |
$2,905.85
|
| Rate for Payer: HFN Commercial |
$3,003.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.75
|
| Rate for Payer: Multiplan Commercial |
$2,612.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,959.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,003.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,599.85
|
| Rate for Payer: Quartz Commercial |
$2,122.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,959.00
|
| Rate for Payer: The Alliance Commercial |
$13,060.00
|
| Rate for Payer: WEA Trust Commercial |
$1,795.75
|
| Rate for Payer: WPS Commercial |
$2,418.39
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.8MM SINGLE-USE 0570-0450
|
Facility
OP
|
$3,344.00
|
|
| Hospital Charge Code |
5520938
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$936.32 |
| Max. Negotiated Rate |
$13,376.00 |
| Rate for Payer: Aetna Commercial |
$3,009.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.84
|
| Rate for Payer: Aetna Managed Medicare |
$936.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,173.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,605.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.32
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,076.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,871.30
|
| Rate for Payer: Health EOS Commercial |
$2,976.16
|
| Rate for Payer: HFN Commercial |
$3,076.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,508.00
|
| Rate for Payer: Multiplan Commercial |
$2,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,006.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.56
|
| Rate for Payer: Quartz Commercial |
$2,173.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,006.40
|
| Rate for Payer: The Alliance Commercial |
$13,376.00
|
| Rate for Payer: WEA Trust Commercial |
$1,839.20
|
| Rate for Payer: WPS Commercial |
$2,476.90
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.8MM SINGLE-USE 0570-0450
|
Facility
IP
|
$3,344.00
|
|
| Hospital Charge Code |
5520938
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,638.56 |
| Max. Negotiated Rate |
$3,076.48 |
| Rate for Payer: Aetna Commercial |
$3,009.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.32
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,076.48
|
| Rate for Payer: Health EOS Commercial |
$2,976.16
|
| Rate for Payer: HFN Commercial |
$3,076.48
|
| Rate for Payer: Multiplan Commercial |
$2,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,006.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.56
|
| Rate for Payer: Quartz Commercial |
$2,006.40
|
| Rate for Payer: WEA Trust Commercial |
$1,839.20
|
| Rate for Payer: WPS Commercial |
$2,476.90
|
|
|
BRONCHOSCOPY
|
Facility
IP
|
$2,051.00
|
|
| Hospital Charge Code |
1186826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,004.99 |
| Max. Negotiated Rate |
$1,886.92 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,230.60
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
BRONCHOSCOPY
|
Facility
OP
|
$2,051.00
|
|
| Hospital Charge Code |
1186826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$8,204.00 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Aetna Managed Medicare |
$574.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.74
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.25
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.60
|
| Rate for Payer: The Alliance Commercial |
$8,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
BRONCHOSCOPY, CLEAR AIRWAYS 31645
|
Professional
|
$1,805.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
3014402
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Aetna Commercial |
$1,714.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$136.85
|
| Rate for Payer: Anthem Medicare Advantage |
$136.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.85
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,714.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$902.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.85
|
| Rate for Payer: Health EOS Commercial |
$1,642.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$495.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$495.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.85
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.75
|
| Rate for Payer: Quartz Beloit One Network |
$794.20
|
| Rate for Payer: Quartz Commercial |
$1,028.85
|
| Rate for Payer: Quartz Medicare Advantage |
$136.85
|
| Rate for Payer: The Alliance Commercial |
$581.61
|
| Rate for Payer: United Healthcare Medicaid |
$273.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.85
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$615.82
|
|
|
BRONCHOSCOPY/LUNG BX, EACH 31628
|
Professional
|
$1,919.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
3014400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.38 |
| Max. Negotiated Rate |
$1,823.05 |
| Rate for Payer: Aetna Commercial |
$1,823.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,650.34
|
| Rate for Payer: Aetna Managed Medicare |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage |
$164.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.38
|
| Rate for Payer: Cash Price |
$575.70
|
| Rate for Payer: Cash Price |
$575.70
|
| Rate for Payer: Cigna Commercial |
$1,823.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.38
|
| Rate for Payer: Health EOS Commercial |
$1,746.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$597.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.38
|
| Rate for Payer: Multiplan Commercial |
$1,535.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.05
|
| Rate for Payer: Quartz Beloit One Network |
$844.36
|
| Rate for Payer: Quartz Commercial |
$1,093.83
|
| Rate for Payer: Quartz Medicare Advantage |
$164.38
|
| Rate for Payer: The Alliance Commercial |
$698.62
|
| Rate for Payer: United Healthcare Medicaid |
$366.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.38
|
| Rate for Payer: WEA Trust Commercial |
$1,055.45
|
| Rate for Payer: WPS Commercial |
$739.71
|
|
|
BRONCHOSCOPY W/FB REMOVAL 31635
|
Professional
|
$2,129.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
3014401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.22 |
| Max. Negotiated Rate |
$2,022.55 |
| Rate for Payer: Aetna Commercial |
$2,022.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,830.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.22
|
| Rate for Payer: Anthem Medicare Advantage |
$162.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.22
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,022.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,064.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.22
|
| Rate for Payer: Health EOS Commercial |
$1,937.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$589.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$589.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.22
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.55
|
| Rate for Payer: Quartz Beloit One Network |
$936.76
|
| Rate for Payer: Quartz Commercial |
$1,213.53
|
| Rate for Payer: Quartz Medicare Advantage |
$162.22
|
| Rate for Payer: The Alliance Commercial |
$689.44
|
| Rate for Payer: United Healthcare Medicaid |
$560.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.22
|
| Rate for Payer: WEA Trust Commercial |
$1,170.95
|
| Rate for Payer: WPS Commercial |
$729.99
|
|
|
BROW LIFT
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
BROW LIFT
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$8.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.82
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.93
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.93
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.93
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.40
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.93
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$8.93
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$8.93
|
| Rate for Payer: Anthem Medicare Advantage |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.93
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.93
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$8.93
|
| Rate for Payer: The Alliance Commercial |
$35.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Brucella IgM
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| 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 |
$8.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.82
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.93
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.93
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.93
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8.93
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$8.93
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Brucella IgM
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| 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
|
|
|
Brucella IgM
|
Professional
|
$89.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$8.93
|
| Rate for Payer: Anthem Medicare Advantage |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.93
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.93
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: Quartz Medicare Advantage |
$8.93
|
| Rate for Payer: The Alliance Commercial |
$35.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
BRUSH CHANNEL CLEANING
|
Facility
OP
|
$63.00
|
|
| Hospital Charge Code |
2972557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
BRUSH CHANNEL CLEANING
|
Facility
IP
|
$63.00
|
|
| Hospital Charge Code |
2972557
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
BRUSH CYTOLOGY 3FR X 115CM CYB-3
|
Facility
OP
|
$2,548.00
|
|
| Hospital Charge Code |
2965411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$10,192.00 |
| Rate for Payer: Aetna Commercial |
$2,293.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,191.28
|
| Rate for Payer: Aetna Managed Medicare |
$713.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,656.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,274.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,223.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,350.44
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$2,344.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,425.86
|
| Rate for Payer: Health EOS Commercial |
$2,267.72
|
| Rate for Payer: HFN Commercial |
$2,344.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,528.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.52
|
| Rate for Payer: Quartz Commercial |
$1,656.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,528.80
|
| Rate for Payer: The Alliance Commercial |
$10,192.00
|
| Rate for Payer: WEA Trust Commercial |
$1,401.40
|
| Rate for Payer: WPS Commercial |
$1,887.30
|
|
|
BRUSH CYTOLOGY 3FR X 115CM CYB-3
|
Facility
IP
|
$2,548.00
|
|
| Hospital Charge Code |
2965411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,248.52 |
| Max. Negotiated Rate |
$2,344.16 |
| Rate for Payer: Aetna Commercial |
$2,293.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,350.44
|
| Rate for Payer: Cash Price |
$764.40
|
| Rate for Payer: Cigna Commercial |
$2,344.16
|
| Rate for Payer: Health EOS Commercial |
$2,267.72
|
| Rate for Payer: HFN Commercial |
$2,344.16
|
| Rate for Payer: Multiplan Commercial |
$2,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,528.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.52
|
| Rate for Payer: Quartz Commercial |
$1,528.80
|
| Rate for Payer: WEA Trust Commercial |
$1,401.40
|
| Rate for Payer: WPS Commercial |
$1,887.30
|
|
|
BRUSH ENDO CYTOLOGY G22409
|
Facility
OP
|
$400.00
|
|
| Hospital Charge Code |
2973004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$360.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| Rate for Payer: Aetna Managed Medicare |
$112.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.84
|
| Rate for Payer: Health EOS Commercial |
$356.00
|
| Rate for Payer: HFN Commercial |
$368.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: NAPHCARE Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$368.00
|
| Rate for Payer: Quartz Beloit One Network |
$196.00
|
| Rate for Payer: Quartz Commercial |
$260.00
|
| Rate for Payer: Quartz Medicare Advantage |
$240.00
|
| Rate for Payer: The Alliance Commercial |
$1,600.00
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
|
BRUSH ENDO CYTOLOGY G22409
|
Facility
IP
|
$400.00
|
|
| Hospital Charge Code |
2973004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Health EOS Commercial |
$356.00
|
| Rate for Payer: HFN Commercial |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: NAPHCARE Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$368.00
|
| Rate for Payer: Quartz Beloit One Network |
$196.00
|
| Rate for Payer: Quartz Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
