|
Islet Cell Antibody Titer
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$98.05 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.69
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$24.51
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
ISNARE LARIAT SNARE BX00711084
|
Facility
|
OP
|
$4,309.00
|
|
| Hospital Charge Code |
5415807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,254.78 |
| Max. Negotiated Rate |
$4,122.85 |
| Rate for Payer: Aetna Commercial |
$4,033.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,254.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,912.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,240.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,151.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,375.12
|
| Rate for Payer: Cash Price |
$1,292.70
|
| Rate for Payer: Cigna Commercial |
$4,122.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,507.84
|
| Rate for Payer: Health EOS Commercial |
$3,988.41
|
| Rate for Payer: HFN Commercial |
$4,122.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.02
|
| Rate for Payer: Multiplan Commercial |
$3,585.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,688.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,122.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.87
|
| Rate for Payer: Quartz Commercial |
$2,912.88
|
| Rate for Payer: Quartz Medicare Advantage |
$2,688.82
|
| Rate for Payer: The Alliance Commercial |
$2,240.68
|
| Rate for Payer: WEA Trust Commercial |
$2,464.75
|
| Rate for Payer: WPS Commercial |
$3,319.22
|
|
|
ISNARE LARIAT SNARE BX00711084
|
Facility
|
IP
|
$4,309.00
|
|
| Hospital Charge Code |
5415807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,195.87 |
| Max. Negotiated Rate |
$4,122.85 |
| Rate for Payer: Aetna Commercial |
$4,033.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,375.12
|
| Rate for Payer: Cash Price |
$1,292.70
|
| Rate for Payer: Cigna Commercial |
$4,122.85
|
| Rate for Payer: Health EOS Commercial |
$3,988.41
|
| Rate for Payer: HFN Commercial |
$4,122.85
|
| Rate for Payer: Multiplan Commercial |
$3,585.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,122.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.87
|
| Rate for Payer: Quartz Commercial |
$2,688.82
|
| Rate for Payer: WEA Trust Commercial |
$2,464.75
|
| Rate for Payer: WPS Commercial |
$3,319.22
|
|
|
Isoagglutinin Titer, Anti-B
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
Isoagglutinin Titer, Anti-B
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$582.66
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
Isoagglutinin Titer, Anti-B
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$738.04 |
| Rate for Payer: Aetna Commercial |
$738.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$738.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$388.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$706.96
|
| Rate for Payer: HFN Commercial |
$738.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$738.04
|
| Rate for Payer: Quartz Beloit One Network |
$341.83
|
| Rate for Payer: Quartz Commercial |
$442.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Isodose Plan Complex
|
Facility
|
IP
|
$3,323.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
3040383
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,693.40 |
| Max. Negotiated Rate |
$3,179.45 |
| Rate for Payer: Aetna Commercial |
$3,110.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.64
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$3,179.45
|
| Rate for Payer: Health EOS Commercial |
$3,075.77
|
| Rate for Payer: HFN Commercial |
$3,179.45
|
| Rate for Payer: Multiplan Commercial |
$2,764.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.40
|
| Rate for Payer: Quartz Commercial |
$2,073.55
|
| Rate for Payer: WEA Trust Commercial |
$1,900.76
|
| Rate for Payer: WPS Commercial |
$2,559.71
|
|
|
Isodose Plan Complex
|
Facility
|
OP
|
$3,323.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
3040383
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$3,179.45 |
| Rate for Payer: Aetna Commercial |
$3,110.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.09
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$3,179.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$3,075.77
|
| Rate for Payer: HFN Commercial |
$3,179.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$2,764.74
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.40
|
| Rate for Payer: Quartz Commercial |
$2,246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$2,591.94
|
| Rate for Payer: WEA Trust Commercial |
$1,900.76
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$2,559.71
|
|
|
Isodose Plan Simple
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
3040381
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.09 |
| Max. Negotiated Rate |
$1,576.18 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$358.28
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$413.40
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
Isodose Plan Simple
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
3040381
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.09 |
| Max. Negotiated Rate |
$507.10 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$330.72
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
Isolation/Extraction Hi Pur Na
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776825
|
|
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
|
|
|
Isolation/Extraction Hi Pur Na
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776825
|
|
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
|
|
|
Isolation/Extraction Hi Pur Na
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776825
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| 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: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Isolation/Extraction Nuc Acid
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| 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: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Isolation/Extraction Nuc Acid
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776826
|
|
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
|
|
|
Isolation/Extraction Nuc Acid
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776826
|
|
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
|
|
|
Isolation Gowns
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040306
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Isolation Gowns
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040306
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Isolation or Extraction
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776823
|
|
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
|
|
|
Isolation or Extraction
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776823
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| 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: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Isolation or Extraction
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776823
|
|
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
|
|
|
Isolation or Extraction of High
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2776824
|
|
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
|
|
|
Isolation or Extraction of High
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776824
|
|
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
|
|
|
Isolation or Extraction of High
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| 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: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
ISO-NEB FILTERED NEBULIZER #1755
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2974730
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
