|
Collagen Type I C-Telopeptide
|
Facility
IP
|
$482.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
1038948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$443.44 |
| Rate for Payer: Aetna Commercial |
$433.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.46
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$443.44
|
| Rate for Payer: Health EOS Commercial |
$428.98
|
| Rate for Payer: HFN Commercial |
$443.44
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: NAPHCARE Commercial |
$289.20
|
| Rate for Payer: Preferred Network Access Commercial |
$443.44
|
| Rate for Payer: Quartz Beloit One Network |
$236.18
|
| Rate for Payer: Quartz Commercial |
$289.20
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
COLLAR CERVICAL 0-6 MONTHS #929200
|
Facility
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERVICAL 0-6 MONTHS #929200
|
Facility
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972055
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERVICAL 2-6 YEARS #929202
|
Facility
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972057
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERVICAL 2-6 YEARS #929202
|
Facility
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972057
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERVICAL 6-12 YEARS #929195
|
Facility
OP
|
$1,103.00
|
|
| Hospital Charge Code |
2972027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$716.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$551.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.24
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
COLLAR CERVICAL 6-12 YEARS #929195
|
Facility
IP
|
$1,103.00
|
|
| Hospital Charge Code |
2972027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
COLLAR CERVICAL 6MONTHS-2YEARS #929201
|
Facility
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2972056
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERVICAL 6MONTHS-2YEARS #929201
|
Facility
OP
|
$1,135.00
|
|
| Hospital Charge Code |
2972056
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
COLLAR CERV RIGID LOW PROFILE ADULT 1.75IN 1044-82
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
5349485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
COLLAR CERV RIGID LOW PROFILE ADULT 1.75IN 1044-82
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
5349485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
COLLAR EXTRICAT BABY NO NECK 980100
|
Facility
OP
|
$163.00
|
|
| Hospital Charge Code |
2963879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
COLLAR EXTRICAT BABY NO NECK 980100
|
Facility
IP
|
$163.00
|
|
| Hospital Charge Code |
2963879
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Collect Blood-Catheter Rad Onc
|
Facility
OP
|
$269.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4494656
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| 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 |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| 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 |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| 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 |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| 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 |
$201.75
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
Collect Blood-Catheter Rad Onc
|
Facility
IP
|
$269.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4494656
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
Collect Blood-Port Rad Onc
|
Facility
IP
|
$185.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
4494655
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$111.00
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Collect Blood-Port Rad Onc
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
4494655
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.80
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| 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 |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| 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 |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| 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 |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$120.25
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$138.75
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
COLLECTION: Venous Draw
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3029072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
COLLECTION: Venous Draw
|
Professional
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3029072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$8.57
|
| Rate for Payer: Anthem Medicare Advantage |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.57
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$42.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.57
|
| Rate for Payer: Health EOS Commercial |
$40.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$42.75
|
| Rate for Payer: Quartz Beloit One Network |
$19.80
|
| Rate for Payer: Quartz Commercial |
$25.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.57
|
| Rate for Payer: The Alliance Commercial |
$36.42
|
| Rate for Payer: United Healthcare Medicaid |
$7.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$37.71
|
|
|
COLLECTION: Venous Draw
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3029072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$8.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicare Advantage |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.57
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.57
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.86
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.57
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: United Healthcare PPO |
$33.75
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: Wellcare Medicare |
$8.57
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
COLLECTOR AUTOLOGOUS TISSUE ABS-1050
|
Facility
OP
|
$4,096.00
|
|
| Hospital Charge Code |
5547217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,146.88 |
| Max. Negotiated Rate |
$16,384.00 |
| Rate for Payer: Aetna Commercial |
$3,686.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,522.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,146.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,662.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,048.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,966.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,170.88
|
| Rate for Payer: Cash Price |
$1,228.80
|
| Rate for Payer: Cigna Commercial |
$3,768.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,292.12
|
| Rate for Payer: Health EOS Commercial |
$3,645.44
|
| Rate for Payer: HFN Commercial |
$3,768.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,072.00
|
| Rate for Payer: Multiplan Commercial |
$3,276.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,768.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,007.04
|
| Rate for Payer: Quartz Commercial |
$2,662.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,457.60
|
| Rate for Payer: The Alliance Commercial |
$16,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,252.80
|
| Rate for Payer: WPS Commercial |
$3,033.91
|
|
|
COLLECTOR AUTOLOGOUS TISSUE ABS-1050
|
Facility
IP
|
$4,096.00
|
|
| Hospital Charge Code |
5547217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,007.04 |
| Max. Negotiated Rate |
$3,768.32 |
| Rate for Payer: Aetna Commercial |
$3,686.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,170.88
|
| Rate for Payer: Cash Price |
$1,228.80
|
| Rate for Payer: Cigna Commercial |
$3,768.32
|
| Rate for Payer: Health EOS Commercial |
$3,645.44
|
| Rate for Payer: HFN Commercial |
$3,768.32
|
| Rate for Payer: Multiplan Commercial |
$3,276.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,768.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,007.04
|
| Rate for Payer: Quartz Commercial |
$2,457.60
|
| Rate for Payer: WEA Trust Commercial |
$2,252.80
|
| Rate for Payer: WPS Commercial |
$3,033.91
|
|
|
COLOCARDS
|
Facility
OP
|
$120.00
|
|
| Hospital Charge Code |
2973174
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: The Alliance Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
COLOCARDS
|
Facility
IP
|
$120.00
|
|
| Hospital Charge Code |
2973174
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Colon Cancer Panel
|
Professional
|
$1,652.00
|
|
|
Service Code
|
CPT 81435
|
| Hospital Charge Code |
4924643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,573.56 |
| Rate for Payer: Aetna Commercial |
$1,569.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,420.72
|
| Rate for Payer: Aetna Managed Medicare |
$584.90
|
| Rate for Payer: Anthem Medicare Advantage |
$584.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$584.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$584.90
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cash Price |
$495.60
|
| Rate for Payer: Cigna Commercial |
$1,569.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$826.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.90
|
| Rate for Payer: Health EOS Commercial |
$1,503.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,064.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,064.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$584.90
|
| Rate for Payer: Multiplan Commercial |
$1,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,569.40
|
| Rate for Payer: Quartz Beloit One Network |
$726.88
|
| Rate for Payer: Quartz Commercial |
$941.64
|
| Rate for Payer: Quartz Medicare Advantage |
$584.90
|
| Rate for Payer: The Alliance Commercial |
$2,310.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$584.90
|
| Rate for Payer: WEA Trust Commercial |
$908.60
|
| Rate for Payer: WPS Commercial |
$2,573.56
|
|
