|
California IgM
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
California IgM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4924648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
California IgM
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4924648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
California IgM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Calprotectin, Stool
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.44 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$288.29
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
Calprotectin, Stool
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$442.04 |
| Rate for Payer: Aetna Commercial |
$432.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Aetna Managed Medicare |
$20.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.89
|
| Rate for Payer: Anthem Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.42
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$442.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.42
|
| Rate for Payer: Health EOS Commercial |
$427.63
|
| Rate for Payer: HFN Commercial |
$442.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: NAPHCARE Commercial |
$30.62
|
| Rate for Payer: Preferred Network Access Commercial |
$442.04
|
| Rate for Payer: Quartz Beloit One Network |
$235.44
|
| Rate for Payer: Quartz Commercial |
$312.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.42
|
| Rate for Payer: The Alliance Commercial |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.42
|
| Rate for Payer: United Healthcare PPO |
$360.36
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: Wellcare Medicare |
$20.42
|
| Rate for Payer: WPS Commercial |
$355.88
|
|
|
Calprotectin, Stool
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
1038824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$456.46 |
| Rate for Payer: Aetna Commercial |
$456.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$413.21
|
| Rate for Payer: Aetna Managed Medicare |
$20.42
|
| Rate for Payer: Anthem Medicare Advantage |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.42
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$456.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.42
|
| Rate for Payer: Health EOS Commercial |
$437.24
|
| Rate for Payer: HFN Commercial |
$456.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.42
|
| Rate for Payer: Multiplan Commercial |
$384.38
|
| Rate for Payer: NAPHCARE Commercial |
$30.62
|
| Rate for Payer: Preferred Network Access Commercial |
$456.46
|
| Rate for Payer: Quartz Beloit One Network |
$211.41
|
| Rate for Payer: Quartz Commercial |
$273.87
|
| Rate for Payer: Quartz Medicare Advantage |
$20.42
|
| Rate for Payer: The Alliance Commercial |
$80.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.42
|
| Rate for Payer: WEA Trust Commercial |
$264.26
|
| Rate for Payer: WPS Commercial |
$89.83
|
|
|
Calreticulin Mutation Analysis
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$469.85 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$575.33
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
Calreticulin Mutation Analysis
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$910.94 |
| Rate for Payer: Aetna Commercial |
$910.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Aetna Managed Medicare |
$126.50
|
| Rate for Payer: Anthem Medicare Advantage |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.50
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$910.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$479.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.50
|
| Rate for Payer: Health EOS Commercial |
$872.58
|
| Rate for Payer: HFN Commercial |
$910.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$446.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: NAPHCARE Commercial |
$189.74
|
| Rate for Payer: Preferred Network Access Commercial |
$910.94
|
| Rate for Payer: Quartz Beloit One Network |
$421.91
|
| Rate for Payer: Quartz Commercial |
$546.56
|
| Rate for Payer: Quartz Medicare Advantage |
$126.50
|
| Rate for Payer: The Alliance Commercial |
$499.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$556.58
|
|
|
Calreticulin Mutation Analysis
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4076003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Aetna Managed Medicare |
$126.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.98
|
| Rate for Payer: Anthem Medicare Advantage |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.50
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.50
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: NAPHCARE Commercial |
$189.74
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$623.27
|
| Rate for Payer: Quartz Medicare Advantage |
$126.50
|
| Rate for Payer: The Alliance Commercial |
$505.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare PPO |
$719.16
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: Wellcare Medicare |
$126.50
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
Calreticulin Mutation US Labs
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$904.02 |
| Rate for Payer: Aetna Commercial |
$904.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$126.50
|
| Rate for Payer: Anthem Medicare Advantage |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$904.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$475.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.50
|
| Rate for Payer: Health EOS Commercial |
$865.96
|
| Rate for Payer: HFN Commercial |
$904.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$446.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$189.74
|
| Rate for Payer: Preferred Network Access Commercial |
$904.02
|
| Rate for Payer: Quartz Beloit One Network |
$418.70
|
| Rate for Payer: Quartz Commercial |
$542.41
|
| Rate for Payer: Quartz Medicare Advantage |
$126.50
|
| Rate for Payer: The Alliance Commercial |
$499.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$556.58
|
|
|
Calreticulin Mutation US Labs
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$126.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.98
|
| Rate for Payer: Anthem Medicare Advantage |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.50
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.50
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$189.74
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$126.50
|
| Rate for Payer: The Alliance Commercial |
$505.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.50
|
| Rate for Payer: United Healthcare PPO |
$713.70
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: Wellcare Medicare |
$126.50
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
Calreticulin Mutation US Labs
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
4852606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
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 |
$32.91 |
| Max. Negotiated Rate |
$1,224.13 |
| Rate for Payer: Aetna Commercial |
$1,224.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.16
|
| Rate for Payer: Aetna Managed Medicare |
$39.68
|
| Rate for Payer: Anthem Medicare Advantage |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.68
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,224.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.68
|
| Rate for Payer: Health EOS Commercial |
$1,172.59
|
| Rate for Payer: HFN Commercial |
$1,224.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.68
|
| Rate for Payer: Multiplan Commercial |
$1,030.85
|
| Rate for Payer: NAPHCARE Commercial |
$59.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.13
|
| Rate for Payer: Quartz Beloit One Network |
$566.97
|
| Rate for Payer: Quartz Commercial |
$734.48
|
| Rate for Payer: Quartz Medicare Advantage |
$39.68
|
| Rate for Payer: The Alliance Commercial |
$99.19
|
| Rate for Payer: United Healthcare Medicaid |
$32.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.68
|
| Rate for Payer: WEA Trust Commercial |
$708.71
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
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 |
$26.20 |
| Max. Negotiated Rate |
$1,224.13 |
| Rate for Payer: Aetna Commercial |
$1,224.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.16
|
| Rate for Payer: Aetna Managed Medicare |
$30.92
|
| Rate for Payer: Anthem Medicare Advantage |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.92
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,224.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.92
|
| Rate for Payer: Health EOS Commercial |
$1,172.59
|
| Rate for Payer: HFN Commercial |
$1,224.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.92
|
| Rate for Payer: Multiplan Commercial |
$1,030.85
|
| Rate for Payer: NAPHCARE Commercial |
$46.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.13
|
| Rate for Payer: Quartz Beloit One Network |
$566.97
|
| Rate for Payer: Quartz Commercial |
$734.48
|
| Rate for Payer: Quartz Medicare Advantage |
$30.92
|
| Rate for Payer: The Alliance Commercial |
$77.30
|
| Rate for Payer: United Healthcare Medicaid |
$26.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.92
|
| Rate for Payer: WEA Trust Commercial |
$708.71
|
| Rate for Payer: WPS Commercial |
$123.68
|
|
|
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 |
$16.68 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$21.60
|
| Rate for Payer: Anthem Medicare Advantage |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.60
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.60
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$86.40
|
|
|
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 |
$13.09 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$15.51
|
| Rate for Payer: Anthem Medicare Advantage |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.51
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.51
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.51
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$23.26
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$15.51
|
| Rate for Payer: The Alliance Commercial |
$38.77
|
| Rate for Payer: United Healthcare Medicaid |
$13.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.51
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$62.03
|
|
|
Camptosar 20 mg Charge
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$639.24 |
| Rate for Payer: Aetna Commercial |
$639.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$1.86
|
| Rate for Payer: Anthem Medicare Advantage |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.86
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$639.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.65
|
| Rate for Payer: Health EOS Commercial |
$612.32
|
| Rate for Payer: HFN Commercial |
$639.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.86
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$2.79
|
| Rate for Payer: Preferred Network Access Commercial |
$639.24
|
| Rate for Payer: Quartz Beloit One Network |
$296.07
|
| Rate for Payer: Quartz Commercial |
$383.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1.86
|
| Rate for Payer: The Alliance Commercial |
$5.12
|
| Rate for Payer: United Healthcare Medicaid |
$1.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.86
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$9.12
|
|
|
Camptosar 20 mg Charge
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$329.71 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
Camptosar 20 mg Charge
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
2958980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$188.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.83
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.66
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$403.73
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$437.37
|
| Rate for Payer: Quartz Medicare Advantage |
$403.73
|
| Rate for Payer: The Alliance Commercial |
$7.45
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$9.12
|
|
|
Cam walker - PT Equipment Issued Rehab
|
Facility
|
IP
|
$843.00
|
|
| Hospital Charge Code |
3007842
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.59 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$526.03
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
|
Cam walker - PT Equipment Issued Rehab
|
Facility
|
OP
|
$843.00
|
|
| Hospital Charge Code |
3007842
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$806.58 |
| Rate for Payer: Aetna Commercial |
$789.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.98
|
| Rate for Payer: Aetna Managed Medicare |
$245.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.66
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna Commercial |
$806.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.63
|
| Rate for Payer: Health EOS Commercial |
$780.28
|
| Rate for Payer: HFN Commercial |
$806.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.54
|
| Rate for Payer: Multiplan Commercial |
$701.38
|
| Rate for Payer: NAPHCARE Commercial |
$526.03
|
| Rate for Payer: Preferred Network Access Commercial |
$806.58
|
| Rate for Payer: Quartz Beloit One Network |
$429.59
|
| Rate for Payer: Quartz Commercial |
$569.87
|
| Rate for Payer: Quartz Medicare Advantage |
$526.03
|
| Rate for Payer: The Alliance Commercial |
$438.36
|
| Rate for Payer: WEA Trust Commercial |
$482.20
|
| Rate for Payer: WPS Commercial |
$649.36
|
|
|
Canalith Repositioning Procedure 95992
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
CPT 95992
|
| Hospital Charge Code |
4524817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$785.46 |
| Rate for Payer: Aetna Commercial |
$785.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.05
|
| Rate for Payer: Aetna Managed Medicare |
$30.23
|
| Rate for Payer: Anthem Medicare Advantage |
$30.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.23
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$785.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.23
|
| Rate for Payer: Health EOS Commercial |
$752.39
|
| Rate for Payer: HFN Commercial |
$785.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.23
|
| Rate for Payer: Multiplan Commercial |
$661.44
|
| Rate for Payer: NAPHCARE Commercial |
$45.35
|
| Rate for Payer: Preferred Network Access Commercial |
$785.46
|
| Rate for Payer: Quartz Beloit One Network |
$363.79
|
| Rate for Payer: Quartz Commercial |
$471.28
|
| Rate for Payer: Quartz Medicare Advantage |
$30.23
|
| Rate for Payer: The Alliance Commercial |
$75.58
|
| Rate for Payer: United Healthcare Medicaid |
$76.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.23
|
| Rate for Payer: WEA Trust Commercial |
$454.74
|
| Rate for Payer: WPS Commercial |
$120.93
|
|
|
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 |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
|
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 |
$82.41 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$82.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$147.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$141.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.71
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.74
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$176.59
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$191.31
|
| Rate for Payer: Quartz Medicare Advantage |
$176.59
|
| Rate for Payer: The Alliance Commercial |
$147.16
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
