|
CV Revision Pacemaker Pocket
|
Professional
|
Both
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.76 |
| Max. Negotiated Rate |
$8,139.14 |
| Rate for Payer: Aetna Commercial |
$8,139.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$290.76
|
| Rate for Payer: Anthem Medicare Advantage |
$290.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.76
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$8,139.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$402.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.76
|
| Rate for Payer: Health EOS Commercial |
$7,796.44
|
| Rate for Payer: HFN Commercial |
$8,139.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,161.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,161.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.76
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$436.14
|
| Rate for Payer: Preferred Network Access Commercial |
$8,139.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,769.71
|
| Rate for Payer: Quartz Commercial |
$4,883.49
|
| Rate for Payer: Quartz Medicare Advantage |
$290.76
|
| Rate for Payer: The Alliance Commercial |
$1,235.74
|
| Rate for Payer: United Healthcare Medicaid |
$402.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.76
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$1,308.43
|
|
|
CV Revision Pacemaker Pocket
|
Facility
|
OP
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| 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 |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,568.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
CV Temporary Pacemaker
|
Professional
|
Both
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$6,072.25 |
| Rate for Payer: Aetna Commercial |
$6,072.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Aetna Managed Medicare |
$129.76
|
| Rate for Payer: Anthem Medicare Advantage |
$129.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.76
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$6,072.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.76
|
| Rate for Payer: Health EOS Commercial |
$5,816.57
|
| Rate for Payer: HFN Commercial |
$6,072.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.76
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: NAPHCARE Commercial |
$194.64
|
| Rate for Payer: Preferred Network Access Commercial |
$6,072.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,812.41
|
| Rate for Payer: Quartz Commercial |
$3,643.35
|
| Rate for Payer: Quartz Medicare Advantage |
$129.76
|
| Rate for Payer: The Alliance Commercial |
$551.48
|
| Rate for Payer: United Healthcare Medicaid |
$181.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.76
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: WPS Commercial |
$583.92
|
|
|
CV Temporary Pacemaker
|
Facility
|
OP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,068.08 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$5,752.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,154.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,195.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,068.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,880.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$5,688.74
|
| Rate for Payer: HFN Commercial |
$5,880.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,880.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.00
|
| Rate for Payer: Quartz Commercial |
$4,154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$4,734.26
|
|
|
CV Temporary Pacemaker
|
Facility
|
IP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,132.00 |
| Max. Negotiated Rate |
$5,880.49 |
| Rate for Payer: Aetna Commercial |
$5,752.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.68
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,880.49
|
| Rate for Payer: Health EOS Commercial |
$5,688.74
|
| Rate for Payer: HFN Commercial |
$5,880.49
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,880.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.00
|
| Rate for Payer: Quartz Commercial |
$3,835.10
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: WPS Commercial |
$4,734.26
|
|
|
CV Venogram Cava Inferior
|
Facility
|
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,259.58 |
| Max. Negotiated Rate |
$9,875.13 |
| Rate for Payer: Aetna Commercial |
$9,660.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,688.94
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,875.13
|
| Rate for Payer: Health EOS Commercial |
$9,553.12
|
| Rate for Payer: HFN Commercial |
$9,875.13
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: Preferred Network Access Commercial |
$9,875.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,259.58
|
| Rate for Payer: Quartz Commercial |
$6,440.30
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: WPS Commercial |
$7,950.27
|
|
|
CV Venogram Cava Inferior
|
Professional
|
Both
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$10,197.15 |
| Rate for Payer: Aetna Commercial |
$10,197.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Aetna Managed Medicare |
$111.60
|
| Rate for Payer: Anthem Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.60
|
| 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 |
$10,197.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,366.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$9,767.79
|
| Rate for Payer: HFN Commercial |
$10,197.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$424.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,197.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,722.89
|
| Rate for Payer: Quartz Commercial |
$6,118.29
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$424.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: WPS Commercial |
$558.01
|
|
|
CV Venogram Cava Inferior
|
Facility
|
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$9,660.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,287.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,829.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,338.17
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,688.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| 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 |
$9,875.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,006.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,553.12
|
| Rate for Payer: HFN Commercial |
$9,875.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,875.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,259.58
|
| Rate for Payer: Quartz Commercial |
$6,977.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,950.27
|
|
|
CV Venogram Cava Superior
|
Professional
|
Both
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$8,935.47 |
| Rate for Payer: Aetna Commercial |
$8,935.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Aetna Managed Medicare |
$116.70
|
| Rate for Payer: Anthem Medicare Advantage |
$116.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.70
|
| 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 |
$8,935.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,702.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.70
|
| Rate for Payer: Health EOS Commercial |
$8,559.24
|
| Rate for Payer: HFN Commercial |
$8,935.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.70
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: NAPHCARE Commercial |
$175.05
|
| Rate for Payer: Preferred Network Access Commercial |
$8,935.47
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.53
|
| Rate for Payer: Quartz Commercial |
$5,361.28
|
| Rate for Payer: Quartz Medicare Advantage |
$116.70
|
| Rate for Payer: The Alliance Commercial |
$443.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.70
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: WPS Commercial |
$583.49
|
|
|
CV Venogram Cava Superior
|
Facility
|
IP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,608.82 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,653.30
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$5,643.46
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
CV Venogram Cava Superior
|
Facility
|
OP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| 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 |
$8,653.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,263.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$6,113.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$0.71
|
| Rate for Payer: Anthem Medicare Advantage |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.71
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.48
|
| Rate for Payer: Health EOS Commercial |
$8.52
|
| Rate for Payer: HFN Commercial |
$8.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$1.06
|
| Rate for Payer: Preferred Network Access Commercial |
$8.89
|
| Rate for Payer: Quartz Beloit One Network |
$4.12
|
| Rate for Payer: Quartz Commercial |
$5.34
|
| Rate for Payer: Quartz Medicare Advantage |
$0.71
|
| Rate for Payer: The Alliance Commercial |
$1.94
|
| Rate for Payer: United Healthcare Medicaid |
$0.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.71
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.96
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$2.83
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Cyclic Citrulline Peptide
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$178.83 |
| Rate for Payer: Aetna Commercial |
$178.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$13.47
|
| Rate for Payer: Anthem Medicare Advantage |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.47
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$178.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.47
|
| Rate for Payer: Health EOS Commercial |
$171.30
|
| Rate for Payer: HFN Commercial |
$178.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.47
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$20.20
|
| Rate for Payer: Preferred Network Access Commercial |
$178.83
|
| Rate for Payer: Quartz Beloit One Network |
$82.83
|
| Rate for Payer: Quartz Commercial |
$107.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.47
|
| Rate for Payer: The Alliance Commercial |
$53.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.47
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Cyclic Citrulline Peptide
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$13.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.36
|
| Rate for Payer: Anthem Medicare Advantage |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.47
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.47
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.47
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$20.20
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$13.47
|
| Rate for Payer: The Alliance Commercial |
$53.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.47
|
| Rate for Payer: United Healthcare PPO |
$141.18
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: Wellcare Medicare |
$13.47
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
Cyclic Citrulline Peptide
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
977918
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.24 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$112.94
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
Cyclospora and Isospora
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$27.41 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$16.09
|
| Rate for Payer: HFN Commercial |
$16.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16.80
|
| Rate for Payer: Quartz Beloit One Network |
$7.78
|
| Rate for Payer: Quartz Commercial |
$10.08
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Cyclospora and Isospora
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$10.61
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Cyclospora and Isospora
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
3449663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$24.92 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.34
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$11.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: United Healthcare PPO |
$13.26
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$6.23
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Cyclospora and Isospora / 10018
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$6.95
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Cyclospora and Isospora / 10018
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Cyclospora and Isospora / 10018
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$30.57 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$30.57
|
|
|
Cyclosporine Level
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
Cyclosporine Level
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.16
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$75.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: United Healthcare PPO |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: Wellcare Medicare |
$18.77
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
