|
Electrolytes Fecal
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$5.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.05
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.05
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$7.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$5.05
|
| Rate for Payer: The Alliance Commercial |
$20.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.05
|
| Rate for Payer: United Healthcare PPO |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$5.05
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Electromylography
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
3005554
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.85
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$546.88
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$631.02
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
Electromylography
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
3005554
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$412.27 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$504.82
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES
|
Facility
|
OP
|
$58.96
|
|
|
Service Code
|
EAPG 00420
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Anthem Medicaid |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$56.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.70
|
| Rate for Payer: Dean Health Medicaid |
$56.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$56.70
|
| Rate for Payer: Managed Health Services Medicaid |
$58.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$56.70
|
| Rate for Payer: United Healthcare Medicaid |
$56.70
|
|
|
Electronic Analysis of Implant 93285
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4163353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$59.30
|
| Rate for Payer: Anthem Medicare Advantage |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$88.95
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: Quartz Medicare Advantage |
$59.30
|
| Rate for Payer: The Alliance Commercial |
$225.34
|
| Rate for Payer: United Healthcare Medicaid |
$35.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$237.20
|
|
|
Electronic Analysis of Implant 9328526
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 93285 26
|
| Hospital Charge Code |
3219473
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$442.62 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$25.25
|
| Rate for Payer: Anthem Medicare Advantage |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.25
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$442.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.25
|
| Rate for Payer: Health EOS Commercial |
$423.99
|
| Rate for Payer: HFN Commercial |
$442.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$37.88
|
| Rate for Payer: Preferred Network Access Commercial |
$442.62
|
| Rate for Payer: Quartz Beloit One Network |
$205.00
|
| Rate for Payer: Quartz Commercial |
$265.57
|
| Rate for Payer: Quartz Medicare Advantage |
$25.25
|
| Rate for Payer: The Alliance Commercial |
$95.95
|
| Rate for Payer: United Healthcare Medicaid |
$22.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$101.00
|
|
|
ELEVIEW SUBMUCOSAL INJECTABLE 9000020
|
Facility
|
IP
|
$1,398.00
|
|
| Hospital Charge Code |
5415878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$712.42 |
| Max. Negotiated Rate |
$1,337.61 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$872.35
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
ELEVIEW SUBMUCOSAL INJECTABLE 9000020
|
Facility
|
OP
|
$1,398.00
|
|
| Hospital Charge Code |
5415878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.10 |
| Max. Negotiated Rate |
$1,337.61 |
| Rate for Payer: Aetna Commercial |
$1,308.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,250.37
|
| Rate for Payer: Aetna Managed Medicare |
$407.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.58
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,337.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.64
|
| Rate for Payer: Health EOS Commercial |
$1,293.99
|
| Rate for Payer: HFN Commercial |
$1,337.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,090.44
|
| Rate for Payer: Multiplan Commercial |
$1,163.14
|
| Rate for Payer: NAPHCARE Commercial |
$872.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,337.61
|
| Rate for Payer: Quartz Beloit One Network |
$712.42
|
| Rate for Payer: Quartz Commercial |
$945.05
|
| Rate for Payer: Quartz Medicare Advantage |
$872.35
|
| Rate for Payer: The Alliance Commercial |
$726.96
|
| Rate for Payer: WEA Trust Commercial |
$799.66
|
| Rate for Payer: WPS Commercial |
$1,076.88
|
|
|
Eligard 22.5 mg/3 months Charge
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$433.31
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$177.61
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$177.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$586.77
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$710.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: Wellcare Medicare |
$177.61
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 22.5 mg/3 months Charge
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$442.33 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$541.63
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$668.62
|
|
|
Eligard 22.5 mg/3 months Charge
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$857.58 |
| Rate for Payer: Aetna Commercial |
$857.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$857.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$821.48
|
| Rate for Payer: HFN Commercial |
$857.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$857.58
|
| Rate for Payer: Quartz Beloit One Network |
$397.20
|
| Rate for Payer: Quartz Commercial |
$514.55
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$488.43
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 30 mg/4 months Charge
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$1,144.10 |
| Rate for Payer: Aetna Commercial |
$1,144.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,144.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$1,095.93
|
| Rate for Payer: HFN Commercial |
$1,144.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.10
|
| Rate for Payer: Quartz Beloit One Network |
$529.90
|
| Rate for Payer: Quartz Commercial |
$686.46
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$488.43
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 30 mg/4 months Charge
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$1,107.97 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$782.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.07
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,107.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$177.61
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$177.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$782.81
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$710.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: Wellcare Medicare |
$177.61
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 30 mg/4 months Charge
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$590.12 |
| Max. Negotiated Rate |
$1,107.97 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,107.97
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$722.59
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$892.01
|
|
|
Eligard 45 mg/6 months Charge
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$1,715.17 |
| Rate for Payer: Aetna Commercial |
$1,715.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,715.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$1,642.95
|
| Rate for Payer: HFN Commercial |
$1,715.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,715.17
|
| Rate for Payer: Quartz Beloit One Network |
$794.39
|
| Rate for Payer: Quartz Commercial |
$1,029.10
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$488.43
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 45 mg/6 months Charge
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$177.61
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$177.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,173.54
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$710.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: Wellcare Medicare |
$177.61
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 45 mg/6 months Charge
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$884.67 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,083.26
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$1,337.24
|
|
|
Eligard 7.5 mg/month Charge
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.25 |
| Max. Negotiated Rate |
$488.43 |
| Rate for Payer: Aetna Commercial |
$285.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$285.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$273.51
|
| Rate for Payer: HFN Commercial |
$285.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$285.53
|
| Rate for Payer: Quartz Beloit One Network |
$132.25
|
| Rate for Payer: Quartz Commercial |
$171.32
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$488.43
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 7.5 mg/month Charge
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.27 |
| Max. Negotiated Rate |
$710.44 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.27
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$177.61
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$177.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$195.36
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$710.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: Wellcare Medicare |
$177.61
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Eligard 7.5 mg/month Charge
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$180.34
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
Eloxatin 0.005 mg Charge
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$0.05
|
| Rate for Payer: Anthem Medicare Advantage |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.05
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.07
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$0.08
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: Quartz Medicare Advantage |
$0.05
|
| Rate for Payer: The Alliance Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicaid |
$0.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.05
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$0.19
|
|
|
Eloxatin 0.005 mg Charge
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.10
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$0.19
|
|
|
Eloxatin 0.005 mg Charge
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Elution
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
973770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Elution
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
973770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| 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 |
$103.07
|
| 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 |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| 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 |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| 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 |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
