|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.01 |
| Max. Negotiated Rate |
$6,117.08 |
| Rate for Payer: Aetna Commercial |
$5,984.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.97
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,117.08
|
| Rate for Payer: Health EOS Commercial |
$5,917.61
|
| Rate for Payer: HFN Commercial |
$6,117.08
|
| Rate for Payer: Multiplan Commercial |
$5,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,989.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,117.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,258.01
|
| Rate for Payer: Quartz Commercial |
$3,989.40
|
| Rate for Payer: WEA Trust Commercial |
$3,656.95
|
| Rate for Payer: WPS Commercial |
$4,924.91
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
IP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,135.11 |
| Max. Negotiated Rate |
$7,763.88 |
| Rate for Payer: Aetna Commercial |
$7,595.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.67
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$7,763.88
|
| Rate for Payer: Health EOS Commercial |
$7,510.71
|
| Rate for Payer: HFN Commercial |
$7,763.88
|
| Rate for Payer: Multiplan Commercial |
$6,751.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,063.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,763.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.11
|
| Rate for Payer: Quartz Commercial |
$5,063.40
|
| Rate for Payer: WEA Trust Commercial |
$4,641.45
|
| Rate for Payer: WPS Commercial |
$6,250.77
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
OP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,362.92 |
| Max. Negotiated Rate |
$7,763.88 |
| Rate for Payer: Aetna Commercial |
$7,595.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,257.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,362.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,485.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,050.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.67
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$7,763.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,722.46
|
| Rate for Payer: Health EOS Commercial |
$7,510.71
|
| Rate for Payer: HFN Commercial |
$7,763.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,329.25
|
| Rate for Payer: Multiplan Commercial |
$6,751.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,063.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,763.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.11
|
| Rate for Payer: Quartz Commercial |
$5,485.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,063.40
|
| Rate for Payer: WEA Trust Commercial |
$4,641.45
|
| Rate for Payer: WPS Commercial |
$6,250.77
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
IP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.84 |
| Max. Negotiated Rate |
$1,946.72 |
| Rate for Payer: Aetna Commercial |
$1,904.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.48
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$1,946.72
|
| Rate for Payer: Health EOS Commercial |
$1,883.24
|
| Rate for Payer: HFN Commercial |
$1,946.72
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.84
|
| Rate for Payer: Quartz Commercial |
$1,269.60
|
| Rate for Payer: WEA Trust Commercial |
$1,163.80
|
| Rate for Payer: WPS Commercial |
$1,567.32
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
OP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.48 |
| Max. Negotiated Rate |
$8,464.00 |
| Rate for Payer: Aetna Commercial |
$1,904.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.76
|
| Rate for Payer: Aetna Managed Medicare |
$592.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,375.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,058.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.48
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$1,946.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,184.11
|
| Rate for Payer: Health EOS Commercial |
$1,883.24
|
| Rate for Payer: HFN Commercial |
$1,946.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.84
|
| Rate for Payer: Quartz Commercial |
$1,375.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.60
|
| Rate for Payer: The Alliance Commercial |
$8,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.80
|
| Rate for Payer: WPS Commercial |
$1,567.32
|
|
|
CEMENT MIXING SYSTEM W/O NOZZLE REVOLUTION 0606-553-000
|
Facility
OP
|
$1,440.00
|
|
| Hospital Charge Code |
2962895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.20 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$1,296.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.40
|
| Rate for Payer: Aetna Managed Medicare |
$403.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.20
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,324.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$805.82
|
| Rate for Payer: Health EOS Commercial |
$1,281.60
|
| Rate for Payer: HFN Commercial |
$1,324.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,080.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,324.80
|
| Rate for Payer: Quartz Beloit One Network |
$705.60
|
| Rate for Payer: Quartz Commercial |
$936.00
|
| Rate for Payer: Quartz Medicare Advantage |
$864.00
|
| Rate for Payer: The Alliance Commercial |
$5,760.00
|
| Rate for Payer: WEA Trust Commercial |
$792.00
|
| Rate for Payer: WPS Commercial |
$1,066.61
|
|
|
CEMENT MIXING SYSTEM W/O NOZZLE REVOLUTION 0606-553-000
|
Facility
IP
|
$1,440.00
|
|
| Hospital Charge Code |
2962895
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.60 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,296.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.20
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,324.80
|
| Rate for Payer: Health EOS Commercial |
$1,281.60
|
| Rate for Payer: HFN Commercial |
$1,324.80
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,324.80
|
| Rate for Payer: Quartz Beloit One Network |
$705.60
|
| Rate for Payer: Quartz Commercial |
$864.00
|
| Rate for Payer: WEA Trust Commercial |
$792.00
|
| Rate for Payer: WPS Commercial |
$1,066.61
|
|
|
Central Line/ CVAD - blood drawn - Central IV Activity:
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
5502701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Central Line/ CVAD - blood drawn - Central IV Activity:
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
5502701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
# Central Line Missed Attempts
|
Facility
OP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.72 |
| Max. Negotiated Rate |
$6,796.00 |
| Rate for Payer: Aetna Commercial |
$1,529.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.14
|
| Rate for Payer: Aetna Managed Medicare |
$475.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,104.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$849.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$815.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.47
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,563.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.76
|
| Rate for Payer: Health EOS Commercial |
$1,512.11
|
| Rate for Payer: HFN Commercial |
$1,563.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.25
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.08
|
| Rate for Payer: Quartz Beloit One Network |
$832.51
|
| Rate for Payer: Quartz Commercial |
$1,104.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,019.40
|
| Rate for Payer: The Alliance Commercial |
$6,796.00
|
| Rate for Payer: WEA Trust Commercial |
$934.45
|
| Rate for Payer: WPS Commercial |
$1,258.45
|
|
|
# Central Line Missed Attempts
|
Facility
IP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$832.51 |
| Max. Negotiated Rate |
$1,563.08 |
| Rate for Payer: Aetna Commercial |
$1,529.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.47
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,563.08
|
| Rate for Payer: Health EOS Commercial |
$1,512.11
|
| Rate for Payer: HFN Commercial |
$1,563.08
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.08
|
| Rate for Payer: Quartz Beloit One Network |
$832.51
|
| Rate for Payer: Quartz Commercial |
$1,019.40
|
| Rate for Payer: WEA Trust Commercial |
$934.45
|
| Rate for Payer: WPS Commercial |
$1,258.45
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.52 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$96.52
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
CENTRAL POST MODULAR GLENOID 30MM AR-9561-30P
|
Facility
OP
|
$6,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,886.64 |
| Max. Negotiated Rate |
$6,198.96 |
| Rate for Payer: Aetna Commercial |
$6,064.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,794.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,886.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,379.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,369.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,234.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,571.14
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,198.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,770.58
|
| Rate for Payer: Health EOS Commercial |
$5,996.82
|
| Rate for Payer: HFN Commercial |
$6,198.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,053.50
|
| Rate for Payer: Multiplan Commercial |
$5,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.62
|
| Rate for Payer: Quartz Commercial |
$4,379.70
|
| Rate for Payer: Quartz Medicare Advantage |
$4,042.80
|
| Rate for Payer: WEA Trust Commercial |
$3,705.90
|
| Rate for Payer: WPS Commercial |
$4,990.84
|
|
|
CENTRAL POST MODULAR GLENOID 30MM AR-9561-30P
|
Facility
IP
|
$6,738.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6201091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,301.62 |
| Max. Negotiated Rate |
$6,198.96 |
| Rate for Payer: Aetna Commercial |
$6,064.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,571.14
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,198.96
|
| Rate for Payer: Health EOS Commercial |
$5,996.82
|
| Rate for Payer: HFN Commercial |
$6,198.96
|
| Rate for Payer: Multiplan Commercial |
$5,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,042.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,198.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,301.62
|
| Rate for Payer: Quartz Commercial |
$4,042.80
|
| Rate for Payer: WEA Trust Commercial |
$3,705.90
|
| Rate for Payer: WPS Commercial |
$4,990.84
|
|
|
Centromere 12
|
Facility
IP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Centromere 12
|
Professional
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna Commercial |
$328.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$328.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$314.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$328.70
|
| Rate for Payer: Quartz Beloit One Network |
$152.24
|
| Rate for Payer: Quartz Commercial |
$197.22
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$202.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$225.24
|
|
|
Centromere 12
|
Facility
OP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.98
|
| Rate for Payer: Anthem Medicaid |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Managed Health Services Medicaid |
$55.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$76.78
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52.89
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$1,384.00
|
| Rate for Payer: United Healthcare Medicaid |
$52.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare PPO |
$259.50
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: Wellcare Medicare |
$51.19
|
| Rate for Payer: WMAP Medicaid |
$52.89
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Centromere B Antibody
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Centromere B Antibody
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Centromere B Antibody
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$70.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$78.89
|
|
|
Centromere to TheraTest
|
Professional
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$78.89 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$70.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$78.89
|
|
|
Centromere to TheraTest
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Centromere to TheraTest
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Cephalic Version - Individual Charges
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3040450
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$332.12 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$216.60
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
