|
CLIP II APPLIER ENDO MD/LG
|
Facility
|
OP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.56 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Aetna Managed Medicare |
$507.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,178.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$870.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.43
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.54
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,178.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.63
|
| Rate for Payer: The Alliance Commercial |
$906.36
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
CLIP II APPLIER ENDO MD/LG
|
Facility
|
IP
|
$1,743.00
|
|
| Hospital Charge Code |
2962904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$888.23 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,087.63
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
CLIP INSTINCT COOK G18343
|
Facility
|
IP
|
$2,682.00
|
|
| Hospital Charge Code |
4520206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,366.75 |
| Max. Negotiated Rate |
$2,566.14 |
| Rate for Payer: Aetna Commercial |
$2,510.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,398.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.32
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$2,566.14
|
| Rate for Payer: Health EOS Commercial |
$2,482.46
|
| Rate for Payer: HFN Commercial |
$2,566.14
|
| Rate for Payer: Multiplan Commercial |
$2,231.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.75
|
| Rate for Payer: Quartz Commercial |
$1,673.57
|
| Rate for Payer: WEA Trust Commercial |
$1,534.10
|
| Rate for Payer: WPS Commercial |
$2,065.94
|
|
|
CLIP INSTINCT COOK G18343
|
Facility
|
OP
|
$2,682.00
|
|
| Hospital Charge Code |
4520206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$2,566.14 |
| Rate for Payer: Aetna Commercial |
$2,510.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,398.78
|
| Rate for Payer: Aetna Managed Medicare |
$781.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,813.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,394.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,338.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,478.32
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna Commercial |
$2,566.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,560.92
|
| Rate for Payer: Health EOS Commercial |
$2,482.46
|
| Rate for Payer: HFN Commercial |
$2,566.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,091.96
|
| Rate for Payer: Multiplan Commercial |
$2,231.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,673.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,366.75
|
| Rate for Payer: Quartz Commercial |
$1,813.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,673.57
|
| Rate for Payer: The Alliance Commercial |
$1,394.64
|
| Rate for Payer: WEA Trust Commercial |
$1,534.10
|
| Rate for Payer: WPS Commercial |
$2,065.94
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
|
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK COLON C913131
|
Facility
|
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$719.16
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
|
OP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$934.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$719.16
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
CLIP PADLOCK EGD C910001
|
Facility
|
IP
|
$1,383.00
|
|
| Hospital Charge Code |
5415937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
Clipper Blades
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Clipper Blades
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3040366
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
CLIPPER NAIL DISPOSABLE
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2965773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
|
IP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,200.62 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,470.14
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
CLIP RESOLUTION 360 M00521232
|
Facility
|
OP
|
$2,356.00
|
|
| Hospital Charge Code |
5414811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$2,254.22 |
| Rate for Payer: Aetna Commercial |
$2,205.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,107.21
|
| Rate for Payer: Aetna Managed Medicare |
$686.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,592.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,225.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,176.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,298.63
|
| Rate for Payer: Cash Price |
$706.80
|
| Rate for Payer: Cigna Commercial |
$2,254.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.19
|
| Rate for Payer: Health EOS Commercial |
$2,180.71
|
| Rate for Payer: HFN Commercial |
$2,254.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,837.68
|
| Rate for Payer: Multiplan Commercial |
$1,960.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,470.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,254.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,200.62
|
| Rate for Payer: Quartz Commercial |
$1,592.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,470.14
|
| Rate for Payer: The Alliance Commercial |
$1,225.12
|
| Rate for Payer: WEA Trust Commercial |
$1,347.63
|
| Rate for Payer: WPS Commercial |
$1,814.83
|
|
|
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
|
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 (1/2 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 (1/4 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
|
|
|
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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
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
|
|
