|
JC Virus, Quantitiative PCR, CSF
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.80
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: HFN Commercial |
$534.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: The Alliance Commercial |
$281.50
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
JC Virus, Quantitiative PCR, CSF
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$337.80
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
JC Virus, Quantitiative PCR, CSF
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.05
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$422.25
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.42
|
| Rate for Payer: Anthem Medicaid |
$6.81
|
| Rate for Payer: Anthem Medicare Advantage |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.89
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Dean Health Medicaid |
$6.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.89
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.84
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.81
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9.89
|
| Rate for Payer: The Alliance Commercial |
$39.56
|
| Rate for Payer: United Healthcare Medicaid |
$6.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.89
|
| Rate for Payer: United Healthcare PPO |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: Wellcare Medicare |
$9.89
|
| Rate for Payer: WMAP Medicaid |
$6.81
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.20
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: HFN Commercial |
$182.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.91
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Jet Stream Catheter
|
Facility
|
OP
|
$22,381.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
4139310
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,266.68 |
| Max. Negotiated Rate |
$89,524.00 |
| Rate for Payer: Aetna Commercial |
$20,142.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,247.66
|
| Rate for Payer: Aetna Managed Medicare |
$6,266.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,547.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,190.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,742.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,861.93
|
| Rate for Payer: Cash Price |
$6,714.30
|
| Rate for Payer: Cigna Commercial |
$20,590.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,524.41
|
| Rate for Payer: Health EOS Commercial |
$19,919.09
|
| Rate for Payer: HFN Commercial |
$20,590.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,785.75
|
| Rate for Payer: Multiplan Commercial |
$17,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,428.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20,590.52
|
| Rate for Payer: Quartz Beloit One Network |
$10,966.69
|
| Rate for Payer: Quartz Commercial |
$14,547.65
|
| Rate for Payer: Quartz Medicare Advantage |
$13,428.60
|
| Rate for Payer: The Alliance Commercial |
$89,524.00
|
| Rate for Payer: WEA Trust Commercial |
$12,309.55
|
| Rate for Payer: WPS Commercial |
$16,577.61
|
|
|
Jet Stream Catheter
|
Facility
|
IP
|
$22,381.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
4139310
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,966.69 |
| Max. Negotiated Rate |
$20,590.52 |
| Rate for Payer: Aetna Commercial |
$20,142.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,247.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,861.93
|
| Rate for Payer: Cash Price |
$6,714.30
|
| Rate for Payer: Cigna Commercial |
$20,590.52
|
| Rate for Payer: Health EOS Commercial |
$19,919.09
|
| Rate for Payer: HFN Commercial |
$20,590.52
|
| Rate for Payer: Multiplan Commercial |
$17,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,428.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20,590.52
|
| Rate for Payer: Quartz Beloit One Network |
$10,966.69
|
| Rate for Payer: Quartz Commercial |
$13,428.60
|
| Rate for Payer: WEA Trust Commercial |
$12,309.55
|
| Rate for Payer: WPS Commercial |
$16,577.61
|
|
|
Jevity 1.2 Rth 1000 mL
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3031441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Jevity 1.2 Rth 1000 mL
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
3031441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Jevity 1.5 Rth 1000 mL
|
Facility
|
OP
|
$97.00
|
|
| Hospital Charge Code |
3031442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Jevity 1.5 Rth 1000 mL
|
Facility
|
IP
|
$97.00
|
|
| Hospital Charge Code |
3031442
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Jevity 1 Rth 1000 mL
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
3031440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Jevity 1 Rth 1000 mL
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
3031440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
J-Loop changed - Peripheral IV Care:
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
3025929
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
J-Loop changed - Peripheral IV Care:
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
3025929
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
J-loop - Peripheral IV Equipment:
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
3003555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
J-loop - Peripheral IV Equipment:
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
3003555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
JO-1 Antibody
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
JO-1 Antibody
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna Commercial |
$187.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$187.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.20
|
| Rate for Payer: Health EOS Commercial |
$179.27
|
| Rate for Payer: HFN Commercial |
$187.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Preferred Network Access Commercial |
$187.15
|
| Rate for Payer: Quartz Beloit One Network |
$86.68
|
| Rate for Payer: Quartz Commercial |
$112.29
|
| Rate for Payer: The Alliance Commercial |
$98.50
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
JO-1 Antibody
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.24
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$147.75
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
JO-1 Antibody
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
JO-1 Antibody
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
JO-1 Antibody
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
JOINT INJECTION INTERMEDIATE JOINT
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
5294615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
