|
Centromere 12
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.37
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$212.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: United Healthcare PPO |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: Wellcare Medicare |
$53.24
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
Centromere 12
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$341.85 |
| Rate for Payer: Aetna Commercial |
$341.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$341.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$327.45
|
| Rate for Payer: HFN Commercial |
$341.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$341.85
|
| Rate for Payer: Quartz Beloit One Network |
$158.33
|
| Rate for Payer: Quartz Commercial |
$205.11
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$210.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$234.25
|
|
|
Centromere 12
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$215.90
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
|
Centromere B Antibody
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Centromere B Antibody
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
Centromere B Antibody
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4518595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Centromere to TheraTest
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
Centromere to TheraTest
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Centromere to TheraTest
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2790817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Cephalic Version - Individual Charges
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3040450
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$180.21 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.21
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$244.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$281.58
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Cephalic Version - Individual Charges
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3040450
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$183.97 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$225.26
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 559MM 2232-01-18
|
Facility
|
IP
|
$3,859.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4434533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.55 |
| Max. Negotiated Rate |
$3,692.29 |
| Rate for Payer: Aetna Commercial |
$3,612.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,451.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,127.08
|
| Rate for Payer: Cash Price |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$3,692.29
|
| Rate for Payer: Health EOS Commercial |
$3,571.89
|
| Rate for Payer: HFN Commercial |
$3,692.29
|
| Rate for Payer: Multiplan Commercial |
$3,210.69
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.55
|
| Rate for Payer: Quartz Commercial |
$2,408.02
|
| Rate for Payer: WEA Trust Commercial |
$2,207.35
|
| Rate for Payer: WPS Commercial |
$2,972.59
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 559MM 2232-01-18
|
Facility
|
OP
|
$3,859.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4434533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.74 |
| Max. Negotiated Rate |
$3,692.29 |
| Rate for Payer: Aetna Commercial |
$3,612.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,451.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,123.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,608.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,006.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,926.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,127.08
|
| Rate for Payer: Cash Price |
$1,157.70
|
| Rate for Payer: Cigna Commercial |
$3,692.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.94
|
| Rate for Payer: Health EOS Commercial |
$3,571.89
|
| Rate for Payer: HFN Commercial |
$3,692.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,010.02
|
| Rate for Payer: Multiplan Commercial |
$3,210.69
|
| Rate for Payer: NAPHCARE Commercial |
$2,408.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.55
|
| Rate for Payer: Quartz Commercial |
$2,608.68
|
| Rate for Payer: Quartz Medicare Advantage |
$2,408.02
|
| Rate for Payer: The Alliance Commercial |
$2,006.68
|
| Rate for Payer: WEA Trust Commercial |
$2,207.35
|
| Rate for Payer: WPS Commercial |
$2,972.59
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 635MM 2232-04-18
|
Facility
|
IP
|
$4,077.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4220574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,077.64 |
| Max. Negotiated Rate |
$3,900.87 |
| Rate for Payer: Aetna Commercial |
$3,816.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,646.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,247.24
|
| Rate for Payer: Cash Price |
$1,223.10
|
| Rate for Payer: Cigna Commercial |
$3,900.87
|
| Rate for Payer: Health EOS Commercial |
$3,773.67
|
| Rate for Payer: HFN Commercial |
$3,900.87
|
| Rate for Payer: Multiplan Commercial |
$3,392.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,900.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,077.64
|
| Rate for Payer: Quartz Commercial |
$2,544.05
|
| Rate for Payer: WEA Trust Commercial |
$2,332.04
|
| Rate for Payer: WPS Commercial |
$3,140.51
|
|
|
CERCLAGE CABLE-READY ASSEMBLY 1.8MM X 635MM 2232-04-18
|
Facility
|
OP
|
$4,077.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
4220574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.22 |
| Max. Negotiated Rate |
$3,900.87 |
| Rate for Payer: Aetna Commercial |
$3,816.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,646.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,187.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,756.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,120.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,035.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,247.24
|
| Rate for Payer: Cash Price |
$1,223.10
|
| Rate for Payer: Cigna Commercial |
$3,900.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,372.81
|
| Rate for Payer: Health EOS Commercial |
$3,773.67
|
| Rate for Payer: HFN Commercial |
$3,900.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,180.06
|
| Rate for Payer: Multiplan Commercial |
$3,392.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,544.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,900.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,077.64
|
| Rate for Payer: Quartz Commercial |
$2,756.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,544.05
|
| Rate for Payer: The Alliance Commercial |
$2,120.04
|
| Rate for Payer: WEA Trust Commercial |
$2,332.04
|
| Rate for Payer: WPS Commercial |
$3,140.51
|
|
|
CERCLAGE SUTURE TENSIONER DISP AR-7820
|
Facility
|
OP
|
$2,705.00
|
|
| Hospital Charge Code |
6166115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.70 |
| Max. Negotiated Rate |
$2,588.14 |
| Rate for Payer: Aetna Commercial |
$2,531.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,419.35
|
| Rate for Payer: Aetna Managed Medicare |
$787.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,828.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,406.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,350.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.00
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,588.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.31
|
| Rate for Payer: Health EOS Commercial |
$2,503.75
|
| Rate for Payer: HFN Commercial |
$2,588.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,109.90
|
| Rate for Payer: Multiplan Commercial |
$2,250.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,687.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.47
|
| Rate for Payer: Quartz Commercial |
$1,828.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,687.92
|
| Rate for Payer: The Alliance Commercial |
$1,406.60
|
| Rate for Payer: WEA Trust Commercial |
$1,547.26
|
| Rate for Payer: WPS Commercial |
$2,083.66
|
|
|
CERCLAGE SUTURE TENSIONER DISP AR-7820
|
Facility
|
IP
|
$2,705.00
|
|
| Hospital Charge Code |
6166115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,378.47 |
| Max. Negotiated Rate |
$2,588.14 |
| Rate for Payer: Aetna Commercial |
$2,531.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,419.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.00
|
| Rate for Payer: Cash Price |
$811.50
|
| Rate for Payer: Cigna Commercial |
$2,588.14
|
| Rate for Payer: Health EOS Commercial |
$2,503.75
|
| Rate for Payer: HFN Commercial |
$2,588.14
|
| Rate for Payer: Multiplan Commercial |
$2,250.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,588.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.47
|
| Rate for Payer: Quartz Commercial |
$1,687.92
|
| Rate for Payer: WEA Trust Commercial |
$1,547.26
|
| Rate for Payer: WPS Commercial |
$2,083.66
|
|
|
CERCLAGE WIRE 0.6MM X 175MM PRCUT 291.240.98
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
CERCLAGE WIRE 0.6MM X 175MM PRCUT 291.240.98
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5831663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.46
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
CEREBRAL PALSY
|
Facility
|
OP
|
$107.44
|
|
|
Service Code
|
EAPG 00536
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Anthem Medicaid |
$103.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$103.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.31
|
| Rate for Payer: Dean Health Medicaid |
$103.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.31
|
| Rate for Payer: Managed Health Services Medicaid |
$107.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.31
|
| Rate for Payer: United Healthcare Medicaid |
$103.31
|
|
|
Cerebrospinal Fluid Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Cerebrospinal Fluid Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
|
Cerebrospinal Fluid Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Ceruloplasmin
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$190.68 |
| Rate for Payer: Aetna Commercial |
$190.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.17
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.17
|
| Rate for Payer: Health EOS Commercial |
$182.66
|
| Rate for Payer: HFN Commercial |
$190.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$16.75
|
| Rate for Payer: Preferred Network Access Commercial |
$190.68
|
| Rate for Payer: Quartz Beloit One Network |
$88.32
|
| Rate for Payer: Quartz Commercial |
$114.41
|
| Rate for Payer: Quartz Medicare Advantage |
$11.17
|
| Rate for Payer: The Alliance Commercial |
$44.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.17
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$49.15
|
|
|
Ceruloplasmin
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
977899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
