|
Cal Vest Test w/recording Bilat Bithermal 92537
|
Professional
|
Both
|
$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: 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 |
$31.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.40
|
| Rate for Payer: Health EOS Commercial |
$1,127.49
|
| Rate for Payer: HFN Commercial |
$1,177.05
|
| 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: 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: The Alliance Commercial |
$619.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.64
|
| Rate for Payer: WEA Trust Commercial |
$681.45
|
| Rate for Payer: WPS Commercial |
$917.73
|
|
|
Cal Vest Test w/recording Bilat Bithermal 9253726
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
CPT 92537 26
|
| Hospital Charge Code |
4598822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.08 |
| 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: 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 |
$743.40
|
| Rate for Payer: Health EOS Commercial |
$1,127.49
|
| Rate for Payer: HFN Commercial |
$1,177.05
|
| 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: 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: The Alliance Commercial |
$619.50
|
| Rate for Payer: WEA Trust Commercial |
$681.45
|
| Rate for Payer: WPS Commercial |
$917.73
|
|
|
Cal Vest Test w/recording Bilat Monothermal 92538
|
Professional
|
Both
|
$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: 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 |
$16.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: HFN Commercial |
$588.05
|
| 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: 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: The Alliance Commercial |
$309.50
|
| Rate for Payer: United Healthcare Medicaid |
$16.04
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Cal Vest Test w/recording Bilat Monothermal 9253826
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 92538 26
|
| Hospital Charge Code |
4598825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| 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 |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: HFN Commercial |
$588.05
|
| 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: 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: The Alliance Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Camptosar 20 mg Charge
|
Professional
|
Both
|
$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: 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 |
$1.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.51
|
| Rate for Payer: Health EOS Commercial |
$588.77
|
| Rate for Payer: HFN Commercial |
$614.65
|
| 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: 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: The Alliance Commercial |
$323.50
|
| Rate for Payer: United Healthcare Medicaid |
$1.95
|
| 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 |
$2,588.00 |
| 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 |
$2,588.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$724.98
|
| 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
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
4524817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| 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 |
$73.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.00
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: HFN Commercial |
$755.25
|
| 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: 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: The Alliance Commercial |
$397.50
|
| Rate for Payer: United Healthcare Medicaid |
$73.77
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| 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
|
|
|
Cancellation Include Discharge
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3243535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.64 |
| 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 |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| 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: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| 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 |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
CANCELLOUS CHIPS 30CC FREEZE DRIED 400150
|
Facility
|
OP
|
$4,930.00
|
|
| Hospital Charge Code |
3167481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.40 |
| Max. Negotiated Rate |
$19,720.00 |
| Rate for Payer: Aetna Commercial |
$4,437.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,239.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,380.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,204.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,465.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,366.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,612.90
|
| Rate for Payer: Cash Price |
$1,479.00
|
| Rate for Payer: Cigna Commercial |
$4,535.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,758.83
|
| Rate for Payer: Health EOS Commercial |
$4,387.70
|
| Rate for Payer: HFN Commercial |
$4,535.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,697.50
|
| Rate for Payer: Multiplan Commercial |
$3,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,958.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,535.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,415.70
|
| Rate for Payer: Quartz Commercial |
$3,204.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,958.00
|
| Rate for Payer: The Alliance Commercial |
$19,720.00
|
| Rate for Payer: WEA Trust Commercial |
$2,711.50
|
| Rate for Payer: WPS Commercial |
$3,651.65
|
|
|
CANCELLOUS CHIPS 30CC FREEZE DRIED 400150
|
Facility
|
IP
|
$4,930.00
|
|
| Hospital Charge Code |
3167481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.70 |
| Max. Negotiated Rate |
$4,535.60 |
| Rate for Payer: Aetna Commercial |
$4,437.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,239.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,612.90
|
| Rate for Payer: Cash Price |
$1,479.00
|
| Rate for Payer: Cigna Commercial |
$4,535.60
|
| Rate for Payer: Health EOS Commercial |
$4,387.70
|
| Rate for Payer: HFN Commercial |
$4,535.60
|
| Rate for Payer: Multiplan Commercial |
$3,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,958.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,535.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,415.70
|
| Rate for Payer: Quartz Commercial |
$2,958.00
|
| Rate for Payer: WEA Trust Commercial |
$2,711.50
|
| Rate for Payer: WPS Commercial |
$3,651.65
|
|
|
CANCELLOUS CHIPS 4-10MM 30CC 100430
|
Facility
|
IP
|
$7,437.00
|
|
| Hospital Charge Code |
4212606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,644.13 |
| Max. Negotiated Rate |
$6,842.04 |
| Rate for Payer: Aetna Commercial |
$6,693.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.61
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna Commercial |
$6,842.04
|
| Rate for Payer: Health EOS Commercial |
$6,618.93
|
| Rate for Payer: HFN Commercial |
$6,842.04
|
| Rate for Payer: Multiplan Commercial |
$5,949.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,462.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.13
|
| Rate for Payer: Quartz Commercial |
$4,462.20
|
| Rate for Payer: WEA Trust Commercial |
$4,090.35
|
| Rate for Payer: WPS Commercial |
$5,508.59
|
|
|
CANCELLOUS CHIPS 4-10MM 30CC 100430
|
Facility
|
OP
|
$7,437.00
|
|
| Hospital Charge Code |
4212606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.36 |
| Max. Negotiated Rate |
$29,748.00 |
| Rate for Payer: Aetna Commercial |
$6,693.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,395.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,082.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,834.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,718.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,569.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,941.61
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna Commercial |
$6,842.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,161.75
|
| Rate for Payer: Health EOS Commercial |
$6,618.93
|
| Rate for Payer: HFN Commercial |
$6,842.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,577.75
|
| Rate for Payer: Multiplan Commercial |
$5,949.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,462.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,842.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,644.13
|
| Rate for Payer: Quartz Commercial |
$4,834.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,462.20
|
| Rate for Payer: The Alliance Commercial |
$29,748.00
|
| Rate for Payer: WEA Trust Commercial |
$4,090.35
|
| Rate for Payer: WPS Commercial |
$5,508.59
|
|
|
Cancer Antigen 125
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.79
|
| Rate for Payer: Dean Health Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$22.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.50
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$83.24
|
| Rate for Payer: United Healthcare Medicaid |
$21.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$21.50
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Cancer Antigen 125
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$199.20
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Cancer Antigen 125
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna Commercial |
$315.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.20
|
| Rate for Payer: Health EOS Commercial |
$302.12
|
| Rate for Payer: HFN Commercial |
$315.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Preferred Network Access Commercial |
$315.40
|
| Rate for Payer: Quartz Beloit One Network |
$146.08
|
| Rate for Payer: Quartz Commercial |
$189.24
|
| Rate for Payer: The Alliance Commercial |
$166.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Cancer Antigen 27 29
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Cancer Antigen 27 29
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.60
|
| Rate for Payer: Health EOS Commercial |
$278.46
|
| Rate for Payer: HFN Commercial |
$290.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$290.70
|
| Rate for Payer: Quartz Beloit One Network |
$134.64
|
| Rate for Payer: Quartz Commercial |
$174.42
|
| Rate for Payer: The Alliance Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Cancer Antigen 27 29
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.24
|
| Rate for Payer: Dean Health Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$22.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.50
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$83.24
|
| Rate for Payer: United Healthcare Medicaid |
$21.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$229.50
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$21.50
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.94
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$48.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
