|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.84 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| 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 |
$45.58
|
| 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 |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| 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 |
$48.13
|
| 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 |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| 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 |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| 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 |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Aetna Commercial |
$106.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.20
|
| Rate for Payer: Health EOS Commercial |
$101.92
|
| Rate for Payer: HFN Commercial |
$106.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.40
|
| Rate for Payer: Quartz Beloit One Network |
$49.28
|
| Rate for Payer: Quartz Commercial |
$63.84
|
| Rate for Payer: The Alliance Commercial |
$56.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
CANISTER 250ML WITH ISOLYZER VIACAN05
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
2973138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Aetna Managed Medicare |
$201.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.35
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$467.35
|
| Rate for Payer: Quartz Medicare Advantage |
$431.40
|
| Rate for Payer: The Alliance Commercial |
$2,876.00
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
CANISTER 250ML WITH ISOLYZER VIACAN05
|
Facility
|
IP
|
$719.00
|
|
| Hospital Charge Code |
2973138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.31 |
| Max. Negotiated Rate |
$661.48 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$431.40
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
CANISTER INFOV.A.C. 1000ML M8275093/5.S
|
Facility
|
OP
|
$821.00
|
|
| Hospital Charge Code |
5415134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$3,284.00 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$229.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$533.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.43
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.75
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$492.60
|
| Rate for Payer: The Alliance Commercial |
$3,284.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
CANISTER INFOV.A.C. 1000ML M8275093/5.S
|
Facility
|
IP
|
$821.00
|
|
| Hospital Charge Code |
5415134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
CANISTER INFOV.A.C. 500ML WITH GEL M8275063/10
|
Facility
|
IP
|
$853.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
3785556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.97 |
| Max. Negotiated Rate |
$784.76 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$511.80
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
CANISTER INFOV.A.C. 500ML WITH GEL M8275063/10
|
Facility
|
OP
|
$853.00
|
|
|
Service Code
|
HCPCS A6550
|
| Hospital Charge Code |
3785556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.84 |
| Max. Negotiated Rate |
$3,412.00 |
| Rate for Payer: Aetna Commercial |
$767.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Aetna Managed Medicare |
$238.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$554.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.09
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$784.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.34
|
| Rate for Payer: Health EOS Commercial |
$759.17
|
| Rate for Payer: HFN Commercial |
$784.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$639.75
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: NAPHCARE Commercial |
$511.80
|
| Rate for Payer: Preferred Network Access Commercial |
$784.76
|
| Rate for Payer: Quartz Beloit One Network |
$417.97
|
| Rate for Payer: Quartz Commercial |
$554.45
|
| Rate for Payer: Quartz Medicare Advantage |
$511.80
|
| Rate for Payer: The Alliance Commercial |
$3,412.00
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
CANISTER KIT W/ISOLYZER #M6275063-10
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
2974089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
CANISTER KIT W/ISOLYZER #M6275063-10
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
2974089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
CANISTER PREVENA 150ML PRE4095
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
5074885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CANISTER PREVENA 150ML PRE4095
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
5074885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CANISTER PREVENA 45ML PRE1095.S
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
4595761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.45 |
| Max. Negotiated Rate |
$464.60 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
CANISTER PREVENA 45ML PRE1095.S
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS A7000
|
| Hospital Charge Code |
4595761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Aetna Managed Medicare |
$141.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$252.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$328.25
|
| Rate for Payer: Quartz Medicare Advantage |
$303.00
|
| Rate for Payer: The Alliance Commercial |
$2,020.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
CANISTER TRUCLEAR HI-FLOW 72200024
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
5074777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
CANISTER TRUCLEAR HI-FLOW 72200024
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
5074777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$76.80
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Cannabinoids, Pnl Serum
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$157.80
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Cannabinoids, Pnl Serum
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna Commercial |
$249.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$249.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.80
|
| Rate for Payer: Health EOS Commercial |
$239.33
|
| Rate for Payer: HFN Commercial |
$249.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Preferred Network Access Commercial |
$249.85
|
| Rate for Payer: Quartz Beloit One Network |
$115.72
|
| Rate for Payer: Quartz Commercial |
$149.91
|
| Rate for Payer: The Alliance Commercial |
$131.50
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Cannabinoids, Pnl Serum
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
5812130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.17
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.25
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$170.95
|
| Rate for Payer: Quartz Medicare Advantage |
$157.80
|
| Rate for Payer: The Alliance Commercial |
$1,052.00
|
| Rate for Payer: United Healthcare PPO |
$197.25
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
