|
Carbohydrate Antigen 19-9
|
Professional
|
$376.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
977889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| 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 |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| 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: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$82.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$91.56
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.38
|
| Rate for Payer: Dean Health Medicaid |
$10.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$10.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.38
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$10.38
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$79.46 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$79.46
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Professional
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$79.46
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Facility
OP
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.38
|
| Rate for Payer: Dean Health Medicaid |
$10.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$10.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.38
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$544.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$10.38
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Carbon Dioxide Level
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Carbon Dioxide Level
|
Professional
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$70.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$4.88
|
| Rate for Payer: Anthem Medicare Advantage |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.88
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.88
|
| Rate for Payer: Health EOS Commercial |
$67.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.30
|
| Rate for Payer: Quartz Beloit One Network |
$32.56
|
| Rate for Payer: Quartz Commercial |
$42.18
|
| Rate for Payer: Quartz Medicare Advantage |
$4.88
|
| Rate for Payer: The Alliance Commercial |
$19.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$21.47
|
|
|
Carbon Dioxide Level
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$4.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.10
|
| Rate for Payer: Anthem Medicaid |
$5.04
|
| Rate for Payer: Anthem Medicare Advantage |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.88
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.04
|
| Rate for Payer: Dean Health Medicaid |
$5.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.88
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.88
|
| Rate for Payer: Managed Health Services Medicaid |
$5.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.32
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4.88
|
| Rate for Payer: The Alliance Commercial |
$296.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: United Healthcare PPO |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$4.88
|
| Rate for Payer: WMAP Medicaid |
$5.04
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
CARBON FIBER ROD 45MM 3.0MM 395.107
|
Facility
IP
|
$539.00
|
|
| Hospital Charge Code |
5517289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$495.88 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$323.40
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
CARBON FIBER ROD 45MM 3.0MM 395.107
|
Facility
OP
|
$539.00
|
|
| Hospital Charge Code |
5517289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$2,156.00 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Aetna Managed Medicare |
$150.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.67
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$495.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.62
|
| Rate for Payer: Health EOS Commercial |
$479.71
|
| Rate for Payer: HFN Commercial |
$495.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: NAPHCARE Commercial |
$323.40
|
| Rate for Payer: Preferred Network Access Commercial |
$495.88
|
| Rate for Payer: Quartz Beloit One Network |
$264.11
|
| Rate for Payer: Quartz Commercial |
$350.35
|
| Rate for Payer: Quartz Medicare Advantage |
$323.40
|
| Rate for Payer: The Alliance Commercial |
$2,156.00
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
CARBON FIBER ROD 60MM 3.0MM 395.109
|
Facility
IP
|
$518.00
|
|
| Hospital Charge Code |
5517288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
CARBON FIBER ROD 60MM 3.0MM 395.109
|
Facility
OP
|
$518.00
|
|
| Hospital Charge Code |
5517288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
CARBON ROD 3MM X 40MM 5079-6-040
|
Facility
IP
|
$885.00
|
|
| Hospital Charge Code |
5349473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 40MM 5079-6-040
|
Facility
OP
|
$885.00
|
|
| Hospital Charge Code |
5349473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Aetna Managed Medicare |
$247.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.25
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.75
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$575.25
|
| Rate for Payer: Quartz Medicare Advantage |
$531.00
|
| Rate for Payer: The Alliance Commercial |
$3,540.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 50MM 5079-6-050
|
Facility
IP
|
$885.00
|
|
| Hospital Charge Code |
5459553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 50MM 5079-6-050
|
Facility
OP
|
$885.00
|
|
| Hospital Charge Code |
5459553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Aetna Managed Medicare |
$247.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.25
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.75
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$575.25
|
| Rate for Payer: Quartz Medicare Advantage |
$531.00
|
| Rate for Payer: The Alliance Commercial |
$3,540.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 60MM 5079-6-060
|
Facility
OP
|
$885.00
|
|
| Hospital Charge Code |
5459554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Aetna Managed Medicare |
$247.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.25
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.75
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$575.25
|
| Rate for Payer: Quartz Medicare Advantage |
$531.00
|
| Rate for Payer: The Alliance Commercial |
$3,540.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 60MM 5079-6-060
|
Facility
IP
|
$885.00
|
|
| Hospital Charge Code |
5459554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 90MM 5079-6-090
|
Facility
IP
|
$885.00
|
|
| Hospital Charge Code |
5459555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
CARBON ROD 3MM X 90MM 5079-6-090
|
Facility
OP
|
$885.00
|
|
| Hospital Charge Code |
5459555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Aetna Managed Medicare |
$247.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.25
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.75
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$575.25
|
| Rate for Payer: Quartz Medicare Advantage |
$531.00
|
| Rate for Payer: The Alliance Commercial |
$3,540.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
OP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$537.04 |
| Max. Negotiated Rate |
$7,672.00 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Aetna Managed Medicare |
$537.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.31
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,438.50
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,246.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.80
|
| Rate for Payer: The Alliance Commercial |
$7,672.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
IP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$939.82 |
| Max. Negotiated Rate |
$1,764.56 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,150.80
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carboxyhemoglobin Level
|
Professional
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna Commercial |
$453.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$453.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$434.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Preferred Network Access Commercial |
$453.15
|
| Rate for Payer: Quartz Beloit One Network |
$209.88
|
| Rate for Payer: Quartz Commercial |
$271.89
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$48.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$54.21
|
|
