|
Carbon Dioxide Level
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna Commercial |
$73.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.08
|
| Rate for Payer: Anthem Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.08
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$73.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.08
|
| Rate for Payer: Health EOS Commercial |
$70.03
|
| Rate for Payer: HFN Commercial |
$73.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$7.61
|
| Rate for Payer: Preferred Network Access Commercial |
$73.11
|
| Rate for Payer: Quartz Beloit One Network |
$33.86
|
| Rate for Payer: Quartz Commercial |
$43.87
|
| Rate for Payer: Quartz Medicare Advantage |
$5.08
|
| Rate for Payer: The Alliance Commercial |
$20.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$22.33
|
|
|
Carbon Dioxide Level
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.08
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.08
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$7.61
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5.08
|
| Rate for Payer: The Alliance Commercial |
$20.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: United Healthcare PPO |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: Wellcare Medicare |
$5.08
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
CARBON FIBER ROD 45MM 3.0MM 395.107
|
Facility
|
OP
|
$539.00
|
|
| Hospital Charge Code |
5517289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$515.72 |
| Rate for Payer: Aetna Commercial |
$504.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.08
|
| Rate for Payer: Aetna Managed Medicare |
$156.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.10
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$515.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.70
|
| Rate for Payer: Health EOS Commercial |
$498.90
|
| Rate for Payer: HFN Commercial |
$515.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.42
|
| Rate for Payer: Multiplan Commercial |
$448.45
|
| Rate for Payer: NAPHCARE Commercial |
$336.34
|
| Rate for Payer: Preferred Network Access Commercial |
$515.72
|
| Rate for Payer: Quartz Beloit One Network |
$274.67
|
| Rate for Payer: Quartz Commercial |
$364.36
|
| Rate for Payer: Quartz Medicare Advantage |
$336.34
|
| Rate for Payer: The Alliance Commercial |
$280.28
|
| Rate for Payer: WEA Trust Commercial |
$308.31
|
| Rate for Payer: WPS Commercial |
$415.19
|
|
|
CARBON FIBER ROD 45MM 3.0MM 395.107
|
Facility
|
IP
|
$539.00
|
|
| Hospital Charge Code |
5517289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.67 |
| Max. Negotiated Rate |
$515.72 |
| Rate for Payer: Aetna Commercial |
$504.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.10
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$515.72
|
| Rate for Payer: Health EOS Commercial |
$498.90
|
| Rate for Payer: HFN Commercial |
$515.72
|
| Rate for Payer: Multiplan Commercial |
$448.45
|
| Rate for Payer: Preferred Network Access Commercial |
$515.72
|
| Rate for Payer: Quartz Beloit One Network |
$274.67
|
| Rate for Payer: Quartz Commercial |
$336.34
|
| Rate for Payer: WEA Trust Commercial |
$308.31
|
| Rate for Payer: WPS Commercial |
$415.19
|
|
|
CARBON FIBER ROD 60MM 3.0MM 395.109
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
5517288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
CARBON FIBER ROD 60MM 3.0MM 395.109
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
5517288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
CARBON ROD 3MM X 40MM 5079-6-040
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
5349473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$257.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.07
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$552.24
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$598.26
|
| Rate for Payer: Quartz Medicare Advantage |
$552.24
|
| Rate for Payer: The Alliance Commercial |
$460.20
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 40MM 5079-6-040
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
5349473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 50MM 5079-6-050
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
5459553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 50MM 5079-6-050
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
5459553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$257.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.07
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$552.24
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$598.26
|
| Rate for Payer: Quartz Medicare Advantage |
$552.24
|
| Rate for Payer: The Alliance Commercial |
$460.20
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 60MM 5079-6-060
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
5459554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$257.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.07
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$552.24
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$598.26
|
| Rate for Payer: Quartz Medicare Advantage |
$552.24
|
| Rate for Payer: The Alliance Commercial |
$460.20
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 60MM 5079-6-060
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
5459554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 90MM 5079-6-090
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
5459555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
CARBON ROD 3MM X 90MM 5079-6-090
|
Facility
|
OP
|
$885.00
|
|
| Hospital Charge Code |
5459555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.71 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$257.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$598.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$460.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.07
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$690.30
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$552.24
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$598.26
|
| Rate for Payer: Quartz Medicare Advantage |
$552.24
|
| Rate for Payer: The Alliance Commercial |
$460.20
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
|
IP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$977.41 |
| Max. Negotiated Rate |
$1,835.14 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,196.83
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
|
OP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$558.52 |
| Max. Negotiated Rate |
$1,835.14 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$558.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,296.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$997.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$957.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,116.28
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,496.04
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,296.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.83
|
| Rate for Payer: The Alliance Commercial |
$997.36
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
Carboxyhemoglobin Level
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.81
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.81
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: NAPHCARE Commercial |
$19.22
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$322.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12.81
|
| Rate for Payer: The Alliance Commercial |
$51.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.81
|
| Rate for Payer: United Healthcare PPO |
$372.06
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: Wellcare Medicare |
$12.81
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Carboxyhemoglobin Level
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$471.28 |
| Rate for Payer: Aetna Commercial |
$471.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Medicare Advantage |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$471.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.81
|
| Rate for Payer: Health EOS Commercial |
$451.43
|
| Rate for Payer: HFN Commercial |
$471.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.81
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: NAPHCARE Commercial |
$19.22
|
| Rate for Payer: Preferred Network Access Commercial |
$471.28
|
| Rate for Payer: Quartz Beloit One Network |
$218.28
|
| Rate for Payer: Quartz Commercial |
$282.77
|
| Rate for Payer: Quartz Medicare Advantage |
$12.81
|
| Rate for Payer: The Alliance Commercial |
$50.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.81
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: WPS Commercial |
$56.38
|
|
|
Carboxyhemoglobin Level
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.08 |
| Max. Negotiated Rate |
$456.39 |
| Rate for Payer: Aetna Commercial |
$446.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.92
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$456.39
|
| Rate for Payer: Health EOS Commercial |
$441.51
|
| Rate for Payer: HFN Commercial |
$456.39
|
| Rate for Payer: Multiplan Commercial |
$396.86
|
| Rate for Payer: Preferred Network Access Commercial |
$456.39
|
| Rate for Payer: Quartz Beloit One Network |
$243.08
|
| Rate for Payer: Quartz Commercial |
$297.65
|
| Rate for Payer: WEA Trust Commercial |
$272.84
|
| Rate for Payer: WPS Commercial |
$367.43
|
|
|
Carcinoembryonic Antigen
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$363.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$19.72
|
| Rate for Payer: Anthem Medicare Advantage |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.72
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$363.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.72
|
| Rate for Payer: Health EOS Commercial |
$348.28
|
| Rate for Payer: HFN Commercial |
$363.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$29.58
|
| Rate for Payer: Preferred Network Access Commercial |
$363.58
|
| Rate for Payer: Quartz Beloit One Network |
$168.40
|
| Rate for Payer: Quartz Commercial |
$218.15
|
| Rate for Payer: Quartz Medicare Advantage |
$19.72
|
| Rate for Payer: The Alliance Commercial |
$77.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.72
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$86.76
|
|
|
Carcinoembryonic Antigen
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.72 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$19.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.72
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.72
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.72
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$29.58
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$19.72
|
| Rate for Payer: The Alliance Commercial |
$78.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.72
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$19.72
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
Carcinoembryonic Antigen
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$247.81 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$247.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.28
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.78
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$531.02
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$575.28
|
| Rate for Payer: Quartz Medicare Advantage |
$531.02
|
| Rate for Payer: The Alliance Commercial |
$442.52
|
| Rate for Payer: United Healthcare PPO |
$663.78
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
Cardiac/Apnea Monitor - Nursery Daily Charges
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
3003953
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
