|
CV Revision Pacemaker Pocket
|
Professional
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$312.66 |
| Max. Negotiated Rate |
$7,826.10 |
| Rate for Payer: Aetna Commercial |
$7,826.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,084.68
|
| Rate for Payer: Aetna Managed Medicare |
$312.66
|
| Rate for Payer: Anthem Medicare Advantage |
$312.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$312.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$312.66
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,826.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,119.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.66
|
| Rate for Payer: Health EOS Commercial |
$7,496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,116.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$312.66
|
| Rate for Payer: Multiplan Commercial |
$6,590.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,826.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,624.72
|
| Rate for Payer: Quartz Commercial |
$4,695.66
|
| Rate for Payer: Quartz Medicare Advantage |
$312.66
|
| Rate for Payer: The Alliance Commercial |
$1,328.80
|
| Rate for Payer: United Healthcare Medicaid |
$386.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.66
|
| Rate for Payer: WEA Trust Commercial |
$4,530.90
|
| Rate for Payer: WPS Commercial |
$1,406.97
|
|
|
CV Temporary Pacemaker
|
Professional
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$143.97 |
| Max. Negotiated Rate |
$5,838.70 |
| Rate for Payer: Aetna Commercial |
$5,838.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,285.56
|
| Rate for Payer: Aetna Managed Medicare |
$143.97
|
| Rate for Payer: Anthem Medicare Advantage |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.97
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,838.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,073.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.97
|
| Rate for Payer: Health EOS Commercial |
$5,592.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$522.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.97
|
| Rate for Payer: Multiplan Commercial |
$4,916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,838.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,704.24
|
| Rate for Payer: Quartz Commercial |
$3,503.22
|
| Rate for Payer: Quartz Medicare Advantage |
$143.97
|
| Rate for Payer: The Alliance Commercial |
$611.87
|
| Rate for Payer: United Healthcare Medicaid |
$174.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.97
|
| Rate for Payer: WEA Trust Commercial |
$3,380.30
|
| Rate for Payer: WPS Commercial |
$647.86
|
|
|
CV Temporary Pacemaker
|
Facility
OP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$2,950.08 |
| Max. Negotiated Rate |
$31,237.55 |
| Rate for Payer: Aetna Commercial |
$5,531.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,285.56
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,994.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,073.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,950.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,654.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$5,469.94
|
| Rate for Payer: HFN Commercial |
$5,654.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$4,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,654.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.54
|
| Rate for Payer: Quartz Commercial |
$3,994.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: WEA Trust Commercial |
$3,380.30
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$4,552.34
|
|
|
CV Temporary Pacemaker
|
Facility
IP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,011.54 |
| Max. Negotiated Rate |
$5,654.32 |
| Rate for Payer: Aetna Commercial |
$5,531.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,257.38
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,654.32
|
| Rate for Payer: Health EOS Commercial |
$5,469.94
|
| Rate for Payer: HFN Commercial |
$5,654.32
|
| Rate for Payer: Multiplan Commercial |
$4,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,687.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,654.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,011.54
|
| Rate for Payer: Quartz Commercial |
$3,687.60
|
| Rate for Payer: WEA Trust Commercial |
$3,380.30
|
| Rate for Payer: WPS Commercial |
$4,552.34
|
|
|
CV Venogram Cava Inferior
|
Professional
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$9,804.95 |
| Rate for Payer: Aetna Commercial |
$9,804.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.80
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,804.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.80
|
| Rate for Payer: Health EOS Commercial |
$9,392.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$408.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,804.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,541.24
|
| Rate for Payer: Quartz Commercial |
$5,882.97
|
| Rate for Payer: Quartz Medicare Advantage |
$108.80
|
| Rate for Payer: The Alliance Commercial |
$413.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.80
|
| Rate for Payer: WEA Trust Commercial |
$5,676.55
|
| Rate for Payer: WPS Commercial |
$544.00
|
|
|
CV Venogram Cava Inferior
|
Facility
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,057.29 |
| Max. Negotiated Rate |
$9,495.32 |
| Rate for Payer: Aetna Commercial |
$9,288.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.13
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,495.32
|
| Rate for Payer: Health EOS Commercial |
$9,185.69
|
| Rate for Payer: HFN Commercial |
$9,495.32
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,495.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.29
|
| Rate for Payer: Quartz Commercial |
$6,192.60
|
| Rate for Payer: WEA Trust Commercial |
$5,676.55
|
| Rate for Payer: WPS Commercial |
$7,644.76
|
|
|
CV Venogram Cava Inferior
|
Facility
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$11,814.49 |
| Rate for Payer: Aetna Commercial |
$9,288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,814.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,451.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,979.01
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,495.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,185.69
|
| Rate for Payer: HFN Commercial |
$9,495.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,495.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.29
|
| Rate for Payer: Quartz Commercial |
$6,708.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,676.55
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,644.76
|
|
|
CV Venogram Cava Superior
|
Facility
IP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,431.56 |
| Max. Negotiated Rate |
$8,320.48 |
| Rate for Payer: Aetna Commercial |
$8,139.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,793.32
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,320.48
|
| Rate for Payer: Health EOS Commercial |
$8,049.16
|
| Rate for Payer: HFN Commercial |
$8,320.48
|
| Rate for Payer: Multiplan Commercial |
$7,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,426.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,320.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,431.56
|
| Rate for Payer: Quartz Commercial |
$5,426.40
|
| Rate for Payer: WEA Trust Commercial |
$4,974.20
|
| Rate for Payer: WPS Commercial |
$6,698.89
|
|
|
CV Venogram Cava Superior
|
Facility
OP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,320.48 |
| Rate for Payer: Aetna Commercial |
$8,139.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,777.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,936.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,748.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,511.46
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,793.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,320.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$8,049.16
|
| Rate for Payer: HFN Commercial |
$8,320.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$7,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,320.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,431.56
|
| Rate for Payer: Quartz Commercial |
$5,878.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$8,217.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$4,974.20
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$6,698.89
|
|
|
CV Venogram Cava Superior
|
Professional
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.95 |
| Max. Negotiated Rate |
$8,591.80 |
| Rate for Payer: Aetna Commercial |
$8,591.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,777.84
|
| Rate for Payer: Aetna Managed Medicare |
$113.95
|
| Rate for Payer: Anthem Medicare Advantage |
$113.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.95
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,591.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,522.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.95
|
| Rate for Payer: Health EOS Commercial |
$8,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.95
|
| Rate for Payer: Multiplan Commercial |
$7,235.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,979.36
|
| Rate for Payer: Quartz Commercial |
$5,155.08
|
| Rate for Payer: Quartz Medicare Advantage |
$113.95
|
| Rate for Payer: The Alliance Commercial |
$433.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.95
|
| Rate for Payer: WEA Trust Commercial |
$4,974.20
|
| Rate for Payer: WPS Commercial |
$569.75
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$1,138.36 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.88
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$1,138.36
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$3.56
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Professional
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$1.31
|
| Rate for Payer: Anthem Medicare Advantage |
$1.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.31
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.42
|
| Rate for Payer: Health EOS Commercial |
$8.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8.55
|
| Rate for Payer: Quartz Beloit One Network |
$3.96
|
| Rate for Payer: Quartz Commercial |
$5.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1.31
|
| Rate for Payer: The Alliance Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicaid |
$1.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.31
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$3.56
|
|
|
Cyclic Citrulline Peptide
|
Facility
IP
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$108.60
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
Cyclic Citrulline Peptide
|
Facility
OP
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$724.00 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.50
|
| Rate for Payer: Anthem Medicaid |
$13.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.95
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.38
|
| Rate for Payer: Dean Health Medicaid |
$13.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.95
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.95
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.42
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.38
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$117.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.95
|
| Rate for Payer: The Alliance Commercial |
$724.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: United Healthcare PPO |
$135.75
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
| Rate for Payer: WMAP Medicaid |
$13.38
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
Cyclic Citrulline Peptide
|
Professional
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$171.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.95
|
| Rate for Payer: Anthem Medicare Advantage |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.95
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$171.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.95
|
| Rate for Payer: Health EOS Commercial |
$164.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.95
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$171.95
|
| Rate for Payer: Quartz Beloit One Network |
$79.64
|
| Rate for Payer: Quartz Commercial |
$103.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12.95
|
| Rate for Payer: The Alliance Commercial |
$51.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.95
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$56.98
|
|
|
Cyclospora and Isospora
|
Professional
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Aetna Managed Medicare |
$5.99
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.99
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.99
|
| Rate for Payer: Health EOS Commercial |
$15.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16.15
|
| Rate for Payer: Quartz Beloit One Network |
$7.48
|
| Rate for Payer: Quartz Commercial |
$9.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5.99
|
| Rate for Payer: The Alliance Commercial |
$23.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$26.36
|
|
|
Cyclospora and Isospora
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Aetna Managed Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.94
|
| Rate for Payer: Anthem Medicaid |
$6.19
|
| Rate for Payer: Anthem Medicare Advantage |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.99
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.19
|
| Rate for Payer: Dean Health Medicaid |
$6.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.99
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$8.98
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.19
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$11.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.99
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.99
|
| Rate for Payer: United Healthcare PPO |
$12.75
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: Wellcare Medicare |
$5.99
|
| Rate for Payer: WMAP Medicaid |
$6.19
|
| Rate for Payer: WPS Commercial |
$12.59
|
|
|
Cyclospora and Isospora
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.64 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$10.20
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$12.59
|
|
|
Cyclospora and Isospora / 10018
|
Professional
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$29.39 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$26.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$29.39
|
|
|
Cyclospora and Isospora / 10018
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.09
|
| Rate for Payer: Anthem Medicaid |
$5.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.25
|
| Rate for Payer: Dean Health Medicaid |
$5.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.25
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$6.68
|
| Rate for Payer: WMAP Medicaid |
$5.25
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Cyclospora and Isospora / 10018
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Cyclosporine Level
|
Professional
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.05
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.05
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: Quartz Medicare Advantage |
$18.05
|
| Rate for Payer: The Alliance Commercial |
$71.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$79.42
|
|
|
Cyclosporine Level
|
Facility
OP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.96
|
| Rate for Payer: Anthem Medicaid |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.05
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.65
|
| Rate for Payer: Dean Health Medicaid |
$18.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.05
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.05
|
| Rate for Payer: Managed Health Services Medicaid |
$19.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.08
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.65
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.05
|
| Rate for Payer: The Alliance Commercial |
$1,264.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare PPO |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: Wellcare Medicare |
$18.05
|
| Rate for Payer: WMAP Medicaid |
$18.65
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Cyclosporine Level
|
Facility
IP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
