|
Enterovirus Culture
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
1039087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.05 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.40
|
| Rate for Payer: Health EOS Commercial |
$158.34
|
| Rate for Payer: HFN Commercial |
$165.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.05
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$165.30
|
| Rate for Payer: Quartz Beloit One Network |
$76.56
|
| Rate for Payer: Quartz Commercial |
$99.18
|
| Rate for Payer: The Alliance Commercial |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Enterovirus Culture
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
1039087
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$160.08 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.22
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$160.08
|
| Rate for Payer: Health EOS Commercial |
$154.86
|
| Rate for Payer: HFN Commercial |
$160.08
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: NAPHCARE Commercial |
$104.40
|
| Rate for Payer: Preferred Network Access Commercial |
$160.08
|
| Rate for Payer: Quartz Beloit One Network |
$85.26
|
| Rate for Payer: Quartz Commercial |
$104.40
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Enterovirus/Parechovirus RNA, Qualitative Real-Time PCR
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
4392583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.62
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$259.50
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Enterovirus/Parechovirus RNA, Qualitative Real-Time PCR
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
4392583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Enterovirus/Parechovirus RNA, Qualitative Real-Time PCR
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
4392583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna Commercial |
$328.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$328.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.60
|
| Rate for Payer: Health EOS Commercial |
$314.86
|
| Rate for Payer: HFN Commercial |
$328.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$328.70
|
| Rate for Payer: Quartz Beloit One Network |
$152.24
|
| Rate for Payer: Quartz Commercial |
$197.22
|
| Rate for Payer: The Alliance Commercial |
$173.00
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
Enterovirus RNA, Qual Real Time PCR
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3256218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Aetna Commercial |
$669.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$669.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$423.00
|
| Rate for Payer: Health EOS Commercial |
$641.55
|
| Rate for Payer: HFN Commercial |
$669.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$669.75
|
| Rate for Payer: Quartz Beloit One Network |
$310.20
|
| Rate for Payer: Quartz Commercial |
$401.85
|
| Rate for Payer: The Alliance Commercial |
$352.50
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
Enterovirus RNA, Qual Real Time PCR
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3256218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$345.45 |
| Max. Negotiated Rate |
$648.60 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$423.00
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
Enterovirus RNA, Qual Real Time PCR
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3256218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$648.60 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.52
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$458.25
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$528.75
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
ENUCLEATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ENUCLEATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ENVELOPE TYRX NEURO ABSORBABLE ANTIBACTERIAL NMRM6122
|
Facility
|
OP
|
$6,866.00
|
|
| Hospital Charge Code |
5617775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,922.48 |
| Max. Negotiated Rate |
$27,464.00 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,922.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,462.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,295.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,842.21
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,149.50
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,462.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,119.60
|
| Rate for Payer: The Alliance Commercial |
$27,464.00
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
ENVELOPE TYRX NEURO ABSORBABLE ANTIBACTERIAL NMRM6122
|
Facility
|
IP
|
$6,866.00
|
|
| Hospital Charge Code |
5617775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,364.34 |
| Max. Negotiated Rate |
$6,316.72 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,119.60
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
ENVERSE per sq cm EN-4040 Q4258
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS Q4258
|
| Hospital Charge Code |
6175132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.33
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: HFN Commercial |
$320.15
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: The Alliance Commercial |
$168.50
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$178.33
|
|
|
ENVERSE per sq cm EN-4040 Q4258
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS Q4258
|
| Hospital Charge Code |
6175132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$94.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.37
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$202.20
|
| Rate for Payer: The Alliance Commercial |
$1,348.00
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$178.33
|
|
|
ENVERSE per sq cm EN-4040 Q4258
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS Q4258
|
| Hospital Charge Code |
6175132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Eosinophil Cationic Protein
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Eosinophil Cationic Protein
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Eosinophil Cationic Protein
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Eosinophil Count, Sputum
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
4494592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Eosinophil Count, Sputum
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
4494592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.20
|
| Rate for Payer: Health EOS Commercial |
$65.52
|
| Rate for Payer: HFN Commercial |
$68.40
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.40
|
| Rate for Payer: Quartz Beloit One Network |
$31.68
|
| Rate for Payer: Quartz Commercial |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Eosinophil Count, Sputum
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 85999
|
| Hospital Charge Code |
4494592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: United Healthcare PPO |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Eosinophil Smear Nasal
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
633721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.61
|
| Rate for Payer: Anthem Medicaid |
$5.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.79
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Dean Health Medicaid |
$5.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.79
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.79
|
| Rate for Payer: Managed Health Services Medicaid |
$6.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.68
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5.79
|
| Rate for Payer: The Alliance Commercial |
$23.16
|
| Rate for Payer: United Healthcare Medicaid |
$5.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.79
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: Wellcare Medicare |
$5.79
|
| Rate for Payer: WMAP Medicaid |
$5.98
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Eosinophil Smear Nasal
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
633721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.44
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Eosinophil Smear Nasal
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
633721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Eosinophil Urine
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
