|
CLIP RESOLUTION 360 ULTRA M00521402
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5927628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,127.74 |
| Max. Negotiated Rate |
$2,117.40 |
| Rate for Payer: Aetna Commercial |
$2,071.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.81
|
| Rate for Payer: Cash Price |
$663.90
|
| Rate for Payer: Cigna Commercial |
$2,117.40
|
| Rate for Payer: Health EOS Commercial |
$2,048.35
|
| Rate for Payer: HFN Commercial |
$2,117.40
|
| Rate for Payer: Multiplan Commercial |
$1,841.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.74
|
| Rate for Payer: Quartz Commercial |
$1,380.91
|
| Rate for Payer: WEA Trust Commercial |
$1,265.84
|
| Rate for Payer: WPS Commercial |
$1,704.67
|
|
|
CLIP RESOLUTION 360 ULTRA M00521402
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5927628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$644.43 |
| Max. Negotiated Rate |
$2,117.40 |
| Rate for Payer: Aetna Commercial |
$2,071.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,979.31
|
| Rate for Payer: Aetna Managed Medicare |
$644.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,495.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,150.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,104.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,219.81
|
| Rate for Payer: Cash Price |
$663.90
|
| Rate for Payer: Cigna Commercial |
$2,117.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,287.97
|
| Rate for Payer: Health EOS Commercial |
$2,048.35
|
| Rate for Payer: HFN Commercial |
$2,117.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.14
|
| Rate for Payer: Multiplan Commercial |
$1,841.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,380.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.74
|
| Rate for Payer: Quartz Commercial |
$1,495.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,380.91
|
| Rate for Payer: The Alliance Commercial |
$1,150.76
|
| Rate for Payer: WEA Trust Commercial |
$1,265.84
|
| Rate for Payer: WPS Commercial |
$1,704.67
|
|
|
CLIP STEALTH LATIS/LATIS 6MM (1/2 FORCE) A1801
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
5729809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
CLIP STEALTH LATIS/LATIS 6MM (1/2 FORCE) A1801
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
5729809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
CLIP STEALTH LATIS/LATIS 6MM (1/4 FORCE) A1602
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
5729811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
CLIP STEALTH LATIS/LATIS 6MM (1/4 FORCE) A1602
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
5729811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
CLL Target Gene Analysis to US Labs
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2794801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$642.42 |
| Rate for Payer: Aetna Commercial |
$400.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$146.01
|
| Rate for Payer: Anthem Commercial |
$79.68
|
| Rate for Payer: Anthem Medicare Advantage |
$146.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.01
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$400.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.01
|
| Rate for Payer: Health EOS Commercial |
$383.29
|
| Rate for Payer: HFN Commercial |
$400.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.01
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$219.01
|
| Rate for Payer: Preferred Network Access Commercial |
$400.14
|
| Rate for Payer: Quartz Beloit One Network |
$185.33
|
| Rate for Payer: Quartz Commercial |
$240.08
|
| Rate for Payer: Quartz Medicare Advantage |
$146.01
|
| Rate for Payer: The Alliance Commercial |
$576.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.01
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$642.42
|
|
|
CLL Target Gene Analysis to US Labs
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2794801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$273.78
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$315.90
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
CLL Target Gene Analysis to US Labs
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2794801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Clobazam (Urbanyl) Level
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3256210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$182.78 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$182.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.44
|
| Rate for Payer: Health EOS Commercial |
$175.08
|
| Rate for Payer: HFN Commercial |
$182.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$182.78
|
| Rate for Payer: Quartz Beloit One Network |
$84.66
|
| Rate for Payer: Quartz Commercial |
$109.67
|
| Rate for Payer: The Alliance Commercial |
$96.20
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Clobazam (Urbanyl) Level
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3256210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.67
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$115.44
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$115.44
|
| Rate for Payer: The Alliance Commercial |
$96.20
|
| Rate for Payer: United Healthcare PPO |
$144.30
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Clobazam (Urbanyl) Level
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3256210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Clomipramine Level and Metabolite
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Clomipramine Level and Metabolite
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Clomipramine Level and Metabolite
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$122.51 |
| Rate for Payer: Aetna Commercial |
$122.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$122.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$117.35
|
| Rate for Payer: HFN Commercial |
$122.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$122.51
|
| Rate for Payer: Quartz Beloit One Network |
$56.74
|
| Rate for Payer: Quartz Commercial |
$73.51
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Clopidogrel CYP2C19 Genotype
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 81225
|
| Hospital Charge Code |
6187246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$1,212.06 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$303.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,136.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$503.00
|
| Rate for Payer: Anthem Medicare Advantage |
$303.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$303.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$303.01
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$303.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$303.01
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,127.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$303.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$303.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$303.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$303.01
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$454.52
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$274.46
|
| Rate for Payer: Quartz Medicare Advantage |
$303.01
|
| Rate for Payer: The Alliance Commercial |
$1,212.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.01
|
| Rate for Payer: United Healthcare PPO |
$316.68
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: Wellcare Medicare |
$303.01
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Clopidogrel CYP2C19 Genotype
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 81225
|
| Hospital Charge Code |
6187246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.79 |
| Max. Negotiated Rate |
$1,333.26 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$303.01
|
| Rate for Payer: Anthem Medicare Advantage |
$303.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$303.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$303.01
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$401.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.01
|
| Rate for Payer: Health EOS Commercial |
$384.24
|
| Rate for Payer: HFN Commercial |
$401.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,069.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$303.01
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$454.52
|
| Rate for Payer: Preferred Network Access Commercial |
$401.13
|
| Rate for Payer: Quartz Beloit One Network |
$185.79
|
| Rate for Payer: Quartz Commercial |
$240.68
|
| Rate for Payer: Quartz Medicare Advantage |
$303.01
|
| Rate for Payer: The Alliance Commercial |
$1,196.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.01
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$1,333.26
|
|
|
Clopidogrel CYP2C19 Genotype
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 81225
|
| Hospital Charge Code |
6187246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
CLOSED REDUCTION ALVEOLAR FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959956
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION ALVEOLAR FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959956
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION ANKLE/TOE FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959957
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION ANKLE/TOE FRACTURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959957
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CLOSED REDUCTION ELBOW/FOREARM FRACTURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959958
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION ELBOW/FOREARM FRACTURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959958
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CLOSED REDUCTION FEMUR FRACTURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959959
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
