|
CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE
|
Facility
|
OP
|
$33.57
|
|
|
Service Code
|
CPT 87086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$33.57 |
| Rate for Payer: Aetna Managed Medicare |
$8.39
|
| Rate for Payer: Anthem Medicare Advantage |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.39
|
| Rate for Payer: NAPHCARE Commercial |
$12.59
|
| Rate for Payer: Quartz Medicare Advantage |
$8.39
|
| Rate for Payer: The Alliance Commercial |
$33.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.39
|
| Rate for Payer: Wellcare Medicare |
$8.39
|
|
|
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood)
|
Facility
|
OP
|
$34.99
|
|
|
Service Code
|
CPT 87102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Aetna Managed Medicare |
$8.75
|
| Rate for Payer: Anthem Medicare Advantage |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.75
|
| Rate for Payer: NAPHCARE Commercial |
$13.12
|
| Rate for Payer: Quartz Medicare Advantage |
$8.75
|
| Rate for Payer: The Alliance Commercial |
$34.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.75
|
| Rate for Payer: Wellcare Medicare |
$8.75
|
|
|
Culture, tubercle or other acid-fast bacilli (e.g., TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates
|
Facility
|
OP
|
$44.93
|
|
|
Service Code
|
CPT 87116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna Managed Medicare |
$11.23
|
| Rate for Payer: Anthem Medicare Advantage |
$11.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.23
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$44.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.23
|
| Rate for Payer: Wellcare Medicare |
$11.23
|
|
|
CUP REVERS UNI 42/ +2MM LT OFFSET AR-9502-42LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNI 42/ +2MM LT OFFSET AR-9502-42LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4268735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNI 42/ +2MM RT OFFSET AR-9502-42RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNI 42/ +2MM RT OFFSET AR-9502-42RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5190741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM LT OFFSET AR-9502-36LCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM LT OFFSET AR-9502-36LCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4519225
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM RT OFFSET AR-9502-36RCPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP REVERS UNIVERSAL 36/ +2MM RT OFFSET AR-9502-36RCPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
CUP STERILE SPECIMEN 4 OZ 2600SA/DYND30389/DYND30331
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3331520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP UNIVERSAL REVERSE CUP - CAP COATED 39/+2MM LT OFFSET AR-9502-39LCPC
|
Facility
|
IP
|
$8,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,473.27 |
| Max. Negotiated Rate |
$8,398.79 |
| Rate for Payer: Health EOS Commercial |
$8,124.92
|
| Rate for Payer: Aetna Commercial |
$8,216.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,851.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.43
|
| Rate for Payer: Cash Price |
$2,633.40
|
| Rate for Payer: Cigna Commercial |
$8,398.79
|
| Rate for Payer: HFN Commercial |
$8,398.79
|
| Rate for Payer: Multiplan Commercial |
$7,303.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.27
|
| Rate for Payer: Quartz Commercial |
$5,477.47
|
| Rate for Payer: WEA Trust Commercial |
$5,021.02
|
| Rate for Payer: WPS Commercial |
$6,761.69
|
|
|
CUP UNIVERSAL REVERSE CUP - CAP COATED 39/+2MM LT OFFSET AR-9502-39LCPC
|
Facility
|
OP
|
$8,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.15 |
| Max. Negotiated Rate |
$8,398.79 |
| Rate for Payer: Aetna Commercial |
$8,216.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,851.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,556.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,933.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,564.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,381.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.43
|
| Rate for Payer: Cash Price |
$2,633.40
|
| Rate for Payer: Cigna Commercial |
$8,398.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,108.80
|
| Rate for Payer: Health EOS Commercial |
$8,124.92
|
| Rate for Payer: HFN Commercial |
$8,398.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,846.84
|
| Rate for Payer: Multiplan Commercial |
$7,303.30
|
| Rate for Payer: NAPHCARE Commercial |
$5,477.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.27
|
| Rate for Payer: Quartz Commercial |
$5,933.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5,477.47
|
| Rate for Payer: The Alliance Commercial |
$4,564.56
|
| Rate for Payer: WEA Trust Commercial |
$5,021.02
|
| Rate for Payer: WPS Commercial |
$6,761.69
|
|
|
Curettage, postpartum
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
Curette/Treat Cornea 65435
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
4608614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$294.42 |
| Rate for Payer: Aetna Commercial |
$294.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$59.97
|
| Rate for Payer: Anthem Medicare Advantage |
$59.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.97
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$294.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.97
|
| Rate for Payer: Health EOS Commercial |
$282.03
|
| Rate for Payer: HFN Commercial |
$294.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.97
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$89.95
|
| Rate for Payer: Preferred Network Access Commercial |
$294.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.36
|
| Rate for Payer: Quartz Commercial |
$176.65
|
| Rate for Payer: Quartz Medicare Advantage |
$59.97
|
| Rate for Payer: The Alliance Commercial |
$254.86
|
| Rate for Payer: United Healthcare Medicaid |
$61.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.97
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$269.85
|
|
|
CUSHION INFLATABLE VINYL
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2964027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CUSHION INFLATABLE VINYL
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2964027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CUSHION WAFFLE SEAT
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
2963017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
CUSHION WAFFLE SEAT
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
2963017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
Cutaneous Direct Immunofluorescence
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2796803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
Cutaneous Direct Immunofluorescence
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2796803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
