|
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 |
$2,457.44 |
| Max. Negotiated Rate |
$8,074.44 |
| Rate for Payer: Aetna Commercial |
$7,898.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,547.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,457.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,704.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,388.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,212.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,651.58
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$8,074.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,911.50
|
| Rate for Payer: Health EOS Commercial |
$7,811.14
|
| Rate for Payer: HFN Commercial |
$8,074.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,582.42
|
| Rate for Payer: Multiplan Commercial |
$7,021.25
|
| Rate for Payer: NAPHCARE Commercial |
$5,265.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,074.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,300.51
|
| Rate for Payer: Quartz Commercial |
$5,704.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5,265.94
|
| Rate for Payer: The Alliance Commercial |
$4,388.28
|
| Rate for Payer: WEA Trust Commercial |
$4,827.11
|
| Rate for Payer: WPS Commercial |
$6,500.56
|
|
|
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 |
$4,300.51 |
| Max. Negotiated Rate |
$8,074.44 |
| Rate for Payer: Aetna Commercial |
$7,898.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,547.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,651.58
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$8,074.44
|
| Rate for Payer: Health EOS Commercial |
$7,811.14
|
| Rate for Payer: HFN Commercial |
$8,074.44
|
| Rate for Payer: Multiplan Commercial |
$7,021.25
|
| Rate for Payer: Preferred Network Access Commercial |
$8,074.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,300.51
|
| Rate for Payer: Quartz Commercial |
$5,265.94
|
| Rate for Payer: WEA Trust Commercial |
$4,827.11
|
| Rate for Payer: WPS Commercial |
$6,500.56
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
OP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.18 |
| Max. Negotiated Rate |
$2,024.59 |
| Rate for Payer: Aetna Commercial |
$1,980.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.55
|
| Rate for Payer: Aetna Managed Medicare |
$616.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,430.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.34
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$2,024.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,231.51
|
| Rate for Payer: Health EOS Commercial |
$1,958.57
|
| Rate for Payer: HFN Commercial |
$2,024.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.31
|
| Rate for Payer: Quartz Commercial |
$1,430.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,320.38
|
| Rate for Payer: The Alliance Commercial |
$1,100.32
|
| Rate for Payer: WEA Trust Commercial |
$1,210.35
|
| Rate for Payer: WPS Commercial |
$1,629.95
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
IP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.31 |
| Max. Negotiated Rate |
$2,024.59 |
| Rate for Payer: Aetna Commercial |
$1,980.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.34
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$2,024.59
|
| Rate for Payer: Health EOS Commercial |
$1,958.57
|
| Rate for Payer: HFN Commercial |
$2,024.59
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.31
|
| Rate for Payer: Quartz Commercial |
$1,320.38
|
| Rate for Payer: WEA Trust Commercial |
$1,210.35
|
| Rate for Payer: WPS Commercial |
$1,629.95
|
|
|
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 |
$733.82 |
| Max. Negotiated Rate |
$1,377.79 |
| Rate for Payer: Aetna Commercial |
$1,347.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.73
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,377.79
|
| Rate for Payer: Health EOS Commercial |
$1,332.86
|
| Rate for Payer: HFN Commercial |
$1,377.79
|
| Rate for Payer: Multiplan Commercial |
$1,198.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.79
|
| Rate for Payer: Quartz Beloit One Network |
$733.82
|
| Rate for Payer: Quartz Commercial |
$898.56
|
| Rate for Payer: WEA Trust Commercial |
$823.68
|
| Rate for Payer: WPS Commercial |
$1,109.23
|
|
|
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 |
$419.33 |
| Max. Negotiated Rate |
$1,377.79 |
| Rate for Payer: Aetna Commercial |
$1,347.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.94
|
| Rate for Payer: Aetna Managed Medicare |
$419.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.73
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cigna Commercial |
$1,377.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.08
|
| Rate for Payer: Health EOS Commercial |
$1,332.86
|
| Rate for Payer: HFN Commercial |
$1,377.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,123.20
|
| Rate for Payer: Multiplan Commercial |
$1,198.08
|
| Rate for Payer: NAPHCARE Commercial |
$898.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.79
|
| Rate for Payer: Quartz Beloit One Network |
$733.82
|
| Rate for Payer: Quartz Commercial |
$973.44
|
| Rate for Payer: Quartz Medicare Advantage |
$898.56
|
| Rate for Payer: The Alliance Commercial |
$748.80
|
| Rate for Payer: WEA Trust Commercial |
$823.68
|
| Rate for Payer: WPS Commercial |
$1,109.23
|
|
|
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 |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
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 |
$106.33 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
# Central Line Missed Attempts
|
Facility
|
IP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.81 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,060.18
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
# Central Line Missed Attempts
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
3811415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.75 |
| Max. Negotiated Rate |
$1,625.60 |
| Rate for Payer: Aetna Commercial |
$1,590.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,519.59
|
| Rate for Payer: Aetna Managed Medicare |
$494.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,148.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$883.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$848.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$936.49
|
| Rate for Payer: Cash Price |
$509.70
|
| Rate for Payer: Cigna Commercial |
$1,625.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.82
|
| Rate for Payer: Health EOS Commercial |
$1,572.59
|
| Rate for Payer: HFN Commercial |
$1,625.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,325.22
|
| Rate for Payer: Multiplan Commercial |
$1,413.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,060.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,625.60
|
| Rate for Payer: Quartz Beloit One Network |
$865.81
|
| Rate for Payer: Quartz Commercial |
$1,148.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,060.18
|
| Rate for Payer: The Alliance Commercial |
$883.48
|
| Rate for Payer: WEA Trust Commercial |
$971.83
|
| Rate for Payer: WPS Commercial |
$1,308.74
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| 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 |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$159.16
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
CENTRAL LINE PLACEMENT
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
2959974
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
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 |
$1,962.11 |
| Max. Negotiated Rate |
$6,446.92 |
| Rate for Payer: Aetna Commercial |
$6,306.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,962.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,554.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,503.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,363.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.99
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,446.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,921.52
|
| Rate for Payer: Health EOS Commercial |
$6,236.69
|
| Rate for Payer: HFN Commercial |
$6,446.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,255.64
|
| Rate for Payer: Multiplan Commercial |
$5,606.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,204.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,446.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.68
|
| Rate for Payer: Quartz Commercial |
$4,554.89
|
| Rate for Payer: Quartz Medicare Advantage |
$4,204.51
|
| Rate for Payer: The Alliance Commercial |
$3,503.76
|
| Rate for Payer: WEA Trust Commercial |
$3,854.14
|
| Rate for Payer: WPS Commercial |
$5,190.28
|
|
|
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 |
$3,433.68 |
| Max. Negotiated Rate |
$6,446.92 |
| Rate for Payer: Aetna Commercial |
$6,306.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,026.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.99
|
| Rate for Payer: Cash Price |
$2,021.40
|
| Rate for Payer: Cigna Commercial |
$6,446.92
|
| Rate for Payer: Health EOS Commercial |
$6,236.69
|
| Rate for Payer: HFN Commercial |
$6,446.92
|
| Rate for Payer: Multiplan Commercial |
$5,606.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,446.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.68
|
| Rate for Payer: Quartz Commercial |
$4,204.51
|
| Rate for Payer: WEA Trust Commercial |
$3,854.14
|
| Rate for Payer: WPS Commercial |
$5,190.28
|
|
|
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: Multiplan Commercial |
$287.87
|
| 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: 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 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 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
|
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 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 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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
