|
California IgM
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
California IgM
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4924648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
California IgM
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4924648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Calprotectin, Stool
|
Facility
IP
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.38 |
| Max. Negotiated Rate |
$425.04 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.86
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$425.04
|
| Rate for Payer: Health EOS Commercial |
$411.18
|
| Rate for Payer: HFN Commercial |
$425.04
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: NAPHCARE Commercial |
$277.20
|
| Rate for Payer: Preferred Network Access Commercial |
$425.04
|
| Rate for Payer: Quartz Beloit One Network |
$226.38
|
| Rate for Payer: Quartz Commercial |
$277.20
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
Calprotectin, Stool
|
Facility
OP
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$1,848.00 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Aetna Managed Medicare |
$19.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.59
|
| Rate for Payer: Anthem Medicaid |
$20.28
|
| Rate for Payer: Anthem Medicare Advantage |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.63
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$425.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.28
|
| Rate for Payer: Dean Health Medicaid |
$20.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.63
|
| Rate for Payer: Health EOS Commercial |
$411.18
|
| Rate for Payer: HFN Commercial |
$425.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.63
|
| Rate for Payer: Managed Health Services Medicaid |
$21.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: NAPHCARE Commercial |
$29.44
|
| Rate for Payer: Preferred Network Access Commercial |
$425.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.28
|
| Rate for Payer: Quartz Beloit One Network |
$226.38
|
| Rate for Payer: Quartz Commercial |
$300.30
|
| Rate for Payer: Quartz Medicare Advantage |
$19.63
|
| Rate for Payer: The Alliance Commercial |
$1,848.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare PPO |
$346.50
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: Wellcare Medicare |
$19.63
|
| Rate for Payer: WMAP Medicaid |
$20.28
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
Calprotectin, Stool
|
Professional
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Aetna Managed Medicare |
$19.63
|
| Rate for Payer: Anthem Medicare Advantage |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.63
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$438.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.63
|
| Rate for Payer: Health EOS Commercial |
$420.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$438.90
|
| Rate for Payer: Quartz Beloit One Network |
$203.28
|
| Rate for Payer: Quartz Commercial |
$263.34
|
| Rate for Payer: Quartz Medicare Advantage |
$19.63
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$86.37
|
|
|
Calreticulin Mutation Analysis
|
Facility
IP
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$848.24 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$553.20
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$553.20
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
Calreticulin Mutation Analysis
|
Facility
OP
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$3,688.00 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Aetna Managed Medicare |
$121.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.91
|
| Rate for Payer: Anthem Medicaid |
$98.08
|
| Rate for Payer: Anthem Medicare Advantage |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.63
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$121.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.08
|
| Rate for Payer: Dean Health Medicaid |
$98.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$121.63
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.63
|
| Rate for Payer: Managed Health Services Medicaid |
$102.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$121.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$121.63
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$182.44
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.08
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$599.30
|
| Rate for Payer: Quartz Medicare Advantage |
$121.63
|
| Rate for Payer: The Alliance Commercial |
$3,688.00
|
| Rate for Payer: United Healthcare Medicaid |
$98.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: United Healthcare PPO |
$691.50
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: Wellcare Medicare |
$121.63
|
| Rate for Payer: WMAP Medicaid |
$98.08
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
Calreticulin Mutation Analysis
|
Professional
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Aetna Commercial |
$875.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Aetna Managed Medicare |
$121.63
|
| Rate for Payer: Anthem Medicare Advantage |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.63
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$875.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$461.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.63
|
| Rate for Payer: Health EOS Commercial |
$839.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.63
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: Preferred Network Access Commercial |
$875.90
|
| Rate for Payer: Quartz Beloit One Network |
$405.68
|
| Rate for Payer: Quartz Commercial |
$525.54
|
| Rate for Payer: Quartz Medicare Advantage |
$121.63
|
| Rate for Payer: The Alliance Commercial |
$480.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$535.17
|
|
|
Calreticulin Mutation US Labs
|
Facility
IP
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
Calreticulin Mutation US Labs
|
Professional
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$869.25 |
| Rate for Payer: Aetna Commercial |
$869.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$121.63
|
| Rate for Payer: Anthem Medicare Advantage |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.63
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$869.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$457.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.63
|
| Rate for Payer: Health EOS Commercial |
$832.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.63
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: Preferred Network Access Commercial |
$869.25
|
| Rate for Payer: Quartz Beloit One Network |
$402.60
|
| Rate for Payer: Quartz Commercial |
$521.55
|
| Rate for Payer: Quartz Medicare Advantage |
$121.63
|
| Rate for Payer: The Alliance Commercial |
$480.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$535.17
|
|
|
Calreticulin Mutation US Labs
|
Facility
OP
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$121.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.91
|
| Rate for Payer: Anthem Medicaid |
$98.08
|
| Rate for Payer: Anthem Medicare Advantage |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.63
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$121.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.08
|
| Rate for Payer: Dean Health Medicaid |
$98.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$121.63
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.63
|
| Rate for Payer: Managed Health Services Medicaid |
$102.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$121.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$121.63
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$182.44
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.08
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$121.63
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: United Healthcare Medicaid |
$98.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.63
|
| Rate for Payer: United Healthcare PPO |
$686.25
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: Wellcare Medicare |
$121.63
|
| Rate for Payer: WMAP Medicaid |
$98.08
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
Cal Vest Test w/recording Bilat Bithermal 92537
|
Professional
|
$1,239.00
|
|
|
Service Code
|
CPT 92537
|
| Hospital Charge Code |
4598821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna Commercial |
$1,177.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.54
|
| Rate for Payer: Aetna Managed Medicare |
$39.22
|
| Rate for Payer: Anthem Medicare Advantage |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.22
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,177.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$619.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.22
|
| Rate for Payer: Health EOS Commercial |
$1,127.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.22
|
| Rate for Payer: Multiplan Commercial |
$991.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.05
|
| Rate for Payer: Quartz Beloit One Network |
$545.16
|
| Rate for Payer: Quartz Commercial |
$706.23
|
| Rate for Payer: Quartz Medicare Advantage |
$39.22
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicaid |
$31.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.22
|
| Rate for Payer: WEA Trust Commercial |
$681.45
|
| Rate for Payer: WPS Commercial |
$156.88
|
|
|
Cal Vest Test w/recording Bilat Bithermal 9253726
|
Professional
|
$1,239.00
|
|
|
Service Code
|
CPT 92537 26
|
| Hospital Charge Code |
4598822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$1,177.05 |
| Rate for Payer: Aetna Commercial |
$1,177.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.54
|
| Rate for Payer: Aetna Managed Medicare |
$30.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.10
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,177.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$619.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.10
|
| Rate for Payer: Health EOS Commercial |
$1,127.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$991.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.05
|
| Rate for Payer: Quartz Beloit One Network |
$545.16
|
| Rate for Payer: Quartz Commercial |
$706.23
|
| Rate for Payer: Quartz Medicare Advantage |
$30.10
|
| Rate for Payer: The Alliance Commercial |
$75.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.10
|
| Rate for Payer: WEA Trust Commercial |
$681.45
|
| Rate for Payer: WPS Commercial |
$120.40
|
|
|
Cal Vest Test w/recording Bilat Monothermal 92538
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 92538
|
| Hospital Charge Code |
4598824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$21.65
|
| Rate for Payer: Anthem Medicare Advantage |
$21.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.65
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.65
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.65
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: Quartz Medicare Advantage |
$21.65
|
| Rate for Payer: The Alliance Commercial |
$54.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.65
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$86.60
|
|
|
Cal Vest Test w/recording Bilat Monothermal 9253826
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 92538 26
|
| Hospital Charge Code |
4598825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.42
|
| Rate for Payer: Anthem Medicare Advantage |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.42
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.42
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.42
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: Quartz Medicare Advantage |
$15.42
|
| Rate for Payer: The Alliance Commercial |
$38.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.42
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$61.68
|
|
|
Camptosar 20 mg Charge
|
Professional
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Aetna Commercial |
$614.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$3.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.00
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$614.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.51
|
| Rate for Payer: Health EOS Commercial |
$588.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Preferred Network Access Commercial |
$614.65
|
| Rate for Payer: Quartz Beloit One Network |
$284.68
|
| Rate for Payer: Quartz Commercial |
$368.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$8.26
|
| Rate for Payer: United Healthcare Medicaid |
$1.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$8.77
|
|
|
Camptosar 20 mg Charge
|
Facility
OP
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$5,411.72 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.64
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.25
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$388.20
|
| Rate for Payer: The Alliance Commercial |
$5,411.72
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$8.77
|
|
|
Camptosar 20 mg Charge
|
Facility
IP
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
Cam walker - PT Equipment Issued Rehab
|
Facility
IP
|
$843.00
|
|
| Hospital Charge Code |
3007842
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$413.07 |
| Max. Negotiated Rate |
$775.56 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$505.80
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
Cam walker - PT Equipment Issued Rehab
|
Facility
OP
|
$843.00
|
|
| Hospital Charge Code |
3007842
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$236.04 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$758.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| Rate for Payer: Aetna Managed Medicare |
$236.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.79
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$775.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.74
|
| Rate for Payer: Health EOS Commercial |
$750.27
|
| Rate for Payer: HFN Commercial |
$775.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.25
|
| Rate for Payer: Multiplan Commercial |
$674.40
|
| Rate for Payer: NAPHCARE Commercial |
$505.80
|
| Rate for Payer: Preferred Network Access Commercial |
$775.56
|
| Rate for Payer: Quartz Beloit One Network |
$413.07
|
| Rate for Payer: Quartz Commercial |
$547.95
|
| Rate for Payer: Quartz Medicare Advantage |
$505.80
|
| Rate for Payer: The Alliance Commercial |
$3,372.00
|
| Rate for Payer: WEA Trust Commercial |
$463.65
|
| Rate for Payer: WPS Commercial |
$624.41
|
|
|
Canalith Repositioning Procedure 95992
|
Professional
|
$795.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
4524817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Aetna Managed Medicare |
$34.86
|
| Rate for Payer: Anthem Medicare Advantage |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.86
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$397.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.86
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.86
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: Quartz Medicare Advantage |
$34.86
|
| Rate for Payer: The Alliance Commercial |
$87.15
|
| Rate for Payer: United Healthcare Medicaid |
$73.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.86
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$139.44
|
|
|
CANAL TIP CO-AXIAL FEMORAL INTERPULSE IRRIGATION 0210-007-000
|
Facility
OP
|
$283.00
|
|
| Hospital Charge Code |
2963187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.37
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$169.80
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
CANAL TIP CO-AXIAL FEMORAL INTERPULSE IRRIGATION 0210-007-000
|
Facility
IP
|
$283.00
|
|
| Hospital Charge Code |
2963187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
Cancellation Include Discharge
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3243535
|
|
Hospital Revenue Code
|
510
|
| 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
|
|
