|
HANDPIECE VERSAJET 52635
|
Facility
|
IP
|
$6,041.00
|
|
| Hospital Charge Code |
2966061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,078.49 |
| Max. Negotiated Rate |
$5,780.03 |
| Rate for Payer: Aetna Commercial |
$5,654.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,403.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,329.80
|
| Rate for Payer: Cash Price |
$1,812.30
|
| Rate for Payer: Cigna Commercial |
$5,780.03
|
| Rate for Payer: Health EOS Commercial |
$5,591.55
|
| Rate for Payer: HFN Commercial |
$5,780.03
|
| Rate for Payer: Multiplan Commercial |
$5,026.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,078.49
|
| Rate for Payer: Quartz Commercial |
$3,769.58
|
| Rate for Payer: WEA Trust Commercial |
$3,455.45
|
| Rate for Payer: WPS Commercial |
$4,653.38
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2020
|
Facility
|
OP
|
$2,308.00
|
|
| Hospital Charge Code |
6178006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.09 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Aetna Managed Medicare |
$672.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,560.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,200.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.26
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,800.24
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,560.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,440.19
|
| Rate for Payer: The Alliance Commercial |
$1,200.16
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2020
|
Facility
|
IP
|
$2,308.00
|
|
| Hospital Charge Code |
6178006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,176.16 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,440.19
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2022
|
Facility
|
OP
|
$2,308.00
|
|
| Hospital Charge Code |
6216962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.09 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Aetna Managed Medicare |
$672.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,560.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,200.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,152.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,343.26
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,800.24
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,560.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,440.19
|
| Rate for Payer: The Alliance Commercial |
$1,200.16
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
HANDPIECE ZEPTO SINGLE USE Z2022
|
Facility
|
IP
|
$2,308.00
|
|
| Hospital Charge Code |
6216962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,176.16 |
| Max. Negotiated Rate |
$2,208.29 |
| Rate for Payer: Aetna Commercial |
$2,160.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,064.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,272.17
|
| Rate for Payer: Cash Price |
$692.40
|
| Rate for Payer: Cigna Commercial |
$2,208.29
|
| Rate for Payer: Health EOS Commercial |
$2,136.28
|
| Rate for Payer: HFN Commercial |
$2,208.29
|
| Rate for Payer: Multiplan Commercial |
$1,920.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,208.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,176.16
|
| Rate for Payer: Quartz Commercial |
$1,440.19
|
| Rate for Payer: WEA Trust Commercial |
$1,320.18
|
| Rate for Payer: WPS Commercial |
$1,777.85
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$52,358.80
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$15,549.77 |
| Max. Negotiated Rate |
$52,358.80 |
| Rate for Payer: Aetna Managed Medicare |
$15,549.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,454.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,474.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,002.99
|
| Rate for Payer: Anthem Medicare Advantage |
$15,549.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,549.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,549.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,549.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,085.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,549.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,158.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,549.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,549.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,549.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,549.77
|
| Rate for Payer: NAPHCARE Commercial |
$23,324.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15,549.77
|
| Rate for Payer: The Alliance Commercial |
$52,358.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,549.77
|
| Rate for Payer: United Healthcare PPO |
$29,707.15
|
| Rate for Payer: Wellcare Medicare |
$15,549.77
|
|
|
HANDSET WITH COMMUNICATOR INTERSTIM TH90G01
|
Facility
|
OP
|
$11,202.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5459150
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,262.02 |
| Max. Negotiated Rate |
$10,718.07 |
| Rate for Payer: Aetna Commercial |
$10,485.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,019.07
|
| Rate for Payer: Aetna Managed Medicare |
$3,262.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,572.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,825.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,592.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,174.54
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$10,718.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,519.56
|
| Rate for Payer: Health EOS Commercial |
$10,368.57
|
| Rate for Payer: HFN Commercial |
$10,718.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,737.56
|
| Rate for Payer: Multiplan Commercial |
$9,320.06
|
| Rate for Payer: NAPHCARE Commercial |
$6,990.05
|
| Rate for Payer: Preferred Network Access Commercial |
$10,718.07
|
| Rate for Payer: Quartz Beloit One Network |
$5,708.54
|
| Rate for Payer: Quartz Commercial |
$7,572.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,990.05
|
| Rate for Payer: The Alliance Commercial |
$5,825.04
|
| Rate for Payer: WEA Trust Commercial |
$6,407.54
|
| Rate for Payer: WPS Commercial |
$8,628.90
|
|
|
HANDSET WITH COMMUNICATOR INTERSTIM TH90G01
|
Facility
|
IP
|
$11,202.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5459150
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5,708.54 |
| Max. Negotiated Rate |
$10,718.07 |
| Rate for Payer: Aetna Commercial |
$10,485.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,019.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,174.54
|
| Rate for Payer: Cash Price |
$3,360.60
|
| Rate for Payer: Cigna Commercial |
$10,718.07
|
| Rate for Payer: Health EOS Commercial |
$10,368.57
|
| Rate for Payer: HFN Commercial |
$10,718.07
|
| Rate for Payer: Multiplan Commercial |
$9,320.06
|
| Rate for Payer: Preferred Network Access Commercial |
$10,718.07
|
| Rate for Payer: Quartz Beloit One Network |
$5,708.54
|
| Rate for Payer: Quartz Commercial |
$6,990.05
|
| Rate for Payer: WEA Trust Commercial |
$6,407.54
|
| Rate for Payer: WPS Commercial |
$8,628.90
|
|
|
HAND, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
HAND, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
Hand Thumb Spica Custom
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
2989892
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$242.07 |
| Rate for Payer: Aetna Commercial |
$236.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.45
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$242.07
|
| Rate for Payer: Health EOS Commercial |
$234.18
|
| Rate for Payer: HFN Commercial |
$242.07
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: Preferred Network Access Commercial |
$242.07
|
| Rate for Payer: Quartz Beloit One Network |
$128.93
|
| Rate for Payer: Quartz Commercial |
$157.87
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$194.89
|
|
|
Hand Thumb Spica Custom
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
2989892
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$1,260.06 |
| Rate for Payer: Aetna Commercial |
$236.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Aetna Managed Medicare |
$73.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.45
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$242.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.25
|
| Rate for Payer: Health EOS Commercial |
$234.18
|
| Rate for Payer: HFN Commercial |
$242.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.34
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: NAPHCARE Commercial |
$157.87
|
| Rate for Payer: Preferred Network Access Commercial |
$242.07
|
| Rate for Payer: Quartz Beloit One Network |
$128.93
|
| Rate for Payer: Quartz Commercial |
$171.03
|
| Rate for Payer: Quartz Medicare Advantage |
$157.87
|
| Rate for Payer: The Alliance Commercial |
$1,260.06
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$194.89
|
|
|
Hantavirus Ab IgM
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Hantavirus Ab IgM
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$68.17 |
| Rate for Payer: Aetna Commercial |
$68.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$65.30
|
| Rate for Payer: HFN Commercial |
$68.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$68.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.57
|
| Rate for Payer: Quartz Commercial |
$40.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Hantavirus Ab IgM
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$53.82
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Hantavirus Antibody IgG, IgM w/Reflex Conformation
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4510574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Haptoglobin
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$181.17
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$52.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: United Healthcare PPO |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: Wellcare Medicare |
$13.08
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Haptoglobin
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Haptoglobin
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$52.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$13.08
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Haptoglobin
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4812609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$83.98 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$51.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$57.57
|
|
|
Haptoglobin
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Haptoglobin
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
633739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Aetna Commercial |
$264.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$264.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$253.64
|
| Rate for Payer: HFN Commercial |
$264.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$264.78
|
| Rate for Payer: Quartz Beloit One Network |
$122.64
|
| Rate for Payer: Quartz Commercial |
$158.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$51.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$57.57
|
|
|
Haptoglubin (FSURE)
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
4538810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$94.85 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$90.85
|
| Rate for Payer: HFN Commercial |
$94.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$94.85
|
| Rate for Payer: Quartz Beloit One Network |
$43.93
|
| Rate for Payer: Quartz Commercial |
$56.91
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$51.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$57.57
|
|
