|
Jak2 Separation
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Jak2 Separation
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
JAK2 V617F Mutation, Quantitative
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$1,204.37 |
| Rate for Payer: Aetna Commercial |
$1,204.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Aetna Managed Medicare |
$95.33
|
| Rate for Payer: Anthem Medicare Advantage |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.33
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,204.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.33
|
| Rate for Payer: Health EOS Commercial |
$1,153.66
|
| Rate for Payer: HFN Commercial |
$1,204.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$336.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.33
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: NAPHCARE Commercial |
$142.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.37
|
| Rate for Payer: Quartz Beloit One Network |
$557.81
|
| Rate for Payer: Quartz Commercial |
$722.62
|
| Rate for Payer: Quartz Medicare Advantage |
$95.33
|
| Rate for Payer: The Alliance Commercial |
$376.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.33
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: WPS Commercial |
$419.44
|
|
|
JAK2 V617F Mutation, Quantitative
|
Facility
|
IP
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$621.20 |
| Max. Negotiated Rate |
$1,166.34 |
| Rate for Payer: Aetna Commercial |
$1,140.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.91
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,166.34
|
| Rate for Payer: Health EOS Commercial |
$1,128.31
|
| Rate for Payer: HFN Commercial |
$1,166.34
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.34
|
| Rate for Payer: Quartz Beloit One Network |
$621.20
|
| Rate for Payer: Quartz Commercial |
$760.66
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: WPS Commercial |
$939.00
|
|
|
JAK2 V617F Mutation, Quantitative
|
Facility
|
OP
|
$1,219.00
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
5313603
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$1,166.34 |
| Rate for Payer: Aetna Commercial |
$1,140.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,090.27
|
| Rate for Payer: Aetna Managed Medicare |
$95.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.24
|
| Rate for Payer: Anthem Medicare Advantage |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.33
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cash Price |
$365.70
|
| Rate for Payer: Cigna Commercial |
$1,166.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$95.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$709.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$95.33
|
| Rate for Payer: Health EOS Commercial |
$1,128.31
|
| Rate for Payer: HFN Commercial |
$1,166.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$95.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$95.33
|
| Rate for Payer: Multiplan Commercial |
$1,014.21
|
| Rate for Payer: NAPHCARE Commercial |
$142.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.34
|
| Rate for Payer: Quartz Beloit One Network |
$621.20
|
| Rate for Payer: Quartz Commercial |
$824.04
|
| Rate for Payer: Quartz Medicare Advantage |
$95.33
|
| Rate for Payer: The Alliance Commercial |
$381.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.33
|
| Rate for Payer: United Healthcare PPO |
$950.82
|
| Rate for Payer: WEA Trust Commercial |
$697.27
|
| Rate for Payer: Wellcare Medicare |
$95.33
|
| Rate for Payer: WPS Commercial |
$939.00
|
|
|
Januvia 1 mg Charge
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$660.09 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$240.03
|
| Rate for Payer: Anthem Medicare Advantage |
$240.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$240.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$240.03
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.23
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$279.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$240.03
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$240.03
|
| Rate for Payer: The Alliance Commercial |
$660.09
|
| Rate for Payer: United Healthcare Medicaid |
$240.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$240.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$550.56
|
|
|
Januvia 1 mg Charge
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$960.13 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$240.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Anthem Medicare Advantage |
$240.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$240.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$240.03
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$240.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$240.03
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$240.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$240.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$240.03
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$240.03
|
| Rate for Payer: The Alliance Commercial |
$960.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$240.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$240.03
|
| Rate for Payer: WPS Commercial |
$550.56
|
|
|
Januvia 1 mg Charge
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
2958864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Jaundice evaluation with lab ordered - Outpatient Newborn Follow-Up Charges
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356649
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$56.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.32
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$121.06
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.06
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Jaundice evaluation with lab ordered - Outpatient Newborn Follow-Up Charges
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356649
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
JAW BRA FACIAL SUPPORT 91
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2963738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
JAW BRA FACIAL SUPPORT 91
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2963738
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
JAW SUBLUXATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
JAW SUBLUXATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960395
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
JAW WIRE 24 GA 200-662
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
JAW WIRE 24 GA 200-662
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2965100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
JC Virus, Quantitiative PCR, CSF
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$286.90 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$351.31
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
JC Virus, Quantitiative PCR, CSF
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$556.24 |
| Rate for Payer: Aetna Commercial |
$556.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$556.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$532.82
|
| Rate for Payer: HFN Commercial |
$556.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$556.24
|
| Rate for Payer: Quartz Beloit One Network |
$257.63
|
| Rate for Payer: Quartz Commercial |
$333.75
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
JC Virus, Quantitiative PCR, CSF
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$380.59
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$439.14
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$10.29
|
| Rate for Payer: Anthem Medicare Advantage |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.29
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.29
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$15.43
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: Quartz Medicare Advantage |
$10.29
|
| Rate for Payer: The Alliance Commercial |
$40.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.29
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$45.26
|
|
|
Jejunal/Duodenal Aspirate, Quant
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 87071
|
| Hospital Charge Code |
4794606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$10.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.07
|
| Rate for Payer: Anthem Medicare Advantage |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.29
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.29
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$15.43
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$10.29
|
| Rate for Payer: The Alliance Commercial |
$41.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.29
|
| Rate for Payer: United Healthcare PPO |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: Wellcare Medicare |
$10.29
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
Jet Stream Catheter
|
Facility
|
OP
|
$22,381.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
4139310
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,517.35 |
| Max. Negotiated Rate |
$21,414.14 |
| Rate for Payer: Aetna Commercial |
$20,948.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,017.57
|
| Rate for Payer: Aetna Managed Medicare |
$6,517.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,129.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,638.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,172.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,336.41
|
| Rate for Payer: Cash Price |
$6,714.30
|
| Rate for Payer: Cigna Commercial |
$21,414.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,025.74
|
| Rate for Payer: Health EOS Commercial |
$20,715.85
|
| Rate for Payer: HFN Commercial |
$21,414.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,457.18
|
| Rate for Payer: Multiplan Commercial |
$18,620.99
|
| Rate for Payer: NAPHCARE Commercial |
$13,965.74
|
| Rate for Payer: Preferred Network Access Commercial |
$21,414.14
|
| Rate for Payer: Quartz Beloit One Network |
$11,405.36
|
| Rate for Payer: Quartz Commercial |
$15,129.56
|
| Rate for Payer: Quartz Medicare Advantage |
$13,965.74
|
| Rate for Payer: The Alliance Commercial |
$11,638.12
|
| Rate for Payer: WEA Trust Commercial |
$12,801.93
|
| Rate for Payer: WPS Commercial |
$17,240.08
|
|
|
Jet Stream Catheter
|
Facility
|
IP
|
$22,381.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
4139310
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,405.36 |
| Max. Negotiated Rate |
$21,414.14 |
| Rate for Payer: Aetna Commercial |
$20,948.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,017.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,336.41
|
| Rate for Payer: Cash Price |
$6,714.30
|
| Rate for Payer: Cigna Commercial |
$21,414.14
|
| Rate for Payer: Health EOS Commercial |
$20,715.85
|
| Rate for Payer: HFN Commercial |
$21,414.14
|
| Rate for Payer: Multiplan Commercial |
$18,620.99
|
| Rate for Payer: Preferred Network Access Commercial |
$21,414.14
|
| Rate for Payer: Quartz Beloit One Network |
$11,405.36
|
| Rate for Payer: Quartz Commercial |
$13,965.74
|
| Rate for Payer: WEA Trust Commercial |
$12,801.93
|
| Rate for Payer: WPS Commercial |
$17,240.08
|
|
|
Jevity 1.2 Rth 1000 mL
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
3031441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
