|
LE/ABD/Pelvic 1st Order
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
3052562
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,206.38 |
| Max. Negotiated Rate |
$2,265.04 |
| Rate for Payer: Aetna Commercial |
$2,215.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,304.86
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,265.04
|
| Rate for Payer: Health EOS Commercial |
$2,191.18
|
| Rate for Payer: HFN Commercial |
$2,265.04
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.38
|
| Rate for Payer: Quartz Commercial |
$1,477.20
|
| Rate for Payer: WEA Trust Commercial |
$1,354.10
|
| Rate for Payer: WPS Commercial |
$1,823.60
|
|
|
LE/ABD/Pelvic 1st Order
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
3052562
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$689.36 |
| Max. Negotiated Rate |
$9,848.00 |
| Rate for Payer: Aetna Commercial |
$2,215.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,117.32
|
| Rate for Payer: Aetna Managed Medicare |
$689.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,600.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,231.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,181.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,304.86
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,265.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$2,191.18
|
| Rate for Payer: HFN Commercial |
$2,265.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,846.50
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,477.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,206.38
|
| Rate for Payer: Quartz Commercial |
$1,600.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,477.20
|
| Rate for Payer: The Alliance Commercial |
$9,848.00
|
| Rate for Payer: WEA Trust Commercial |
$1,354.10
|
| Rate for Payer: WPS Commercial |
$1,823.60
|
|
|
LE/ABD/Pelvic 2nd Order
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
3052563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$453.32 |
| Max. Negotiated Rate |
$6,476.00 |
| Rate for Payer: Aetna Commercial |
$1,457.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,392.34
|
| Rate for Payer: Aetna Managed Medicare |
$453.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,052.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$777.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$858.07
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,489.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,440.91
|
| Rate for Payer: HFN Commercial |
$1,489.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,214.25
|
| Rate for Payer: Multiplan Commercial |
$1,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$971.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,489.48
|
| Rate for Payer: Quartz Beloit One Network |
$793.31
|
| Rate for Payer: Quartz Commercial |
$1,052.35
|
| Rate for Payer: Quartz Medicare Advantage |
$971.40
|
| Rate for Payer: The Alliance Commercial |
$6,476.00
|
| Rate for Payer: WEA Trust Commercial |
$890.45
|
| Rate for Payer: WPS Commercial |
$1,199.19
|
|
|
LE/ABD/Pelvic 2nd Order
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
3052563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$793.31 |
| Max. Negotiated Rate |
$1,489.48 |
| Rate for Payer: Aetna Commercial |
$1,457.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,392.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$858.07
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,489.48
|
| Rate for Payer: Health EOS Commercial |
$1,440.91
|
| Rate for Payer: HFN Commercial |
$1,489.48
|
| Rate for Payer: Multiplan Commercial |
$1,295.20
|
| Rate for Payer: NAPHCARE Commercial |
$971.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,489.48
|
| Rate for Payer: Quartz Beloit One Network |
$793.31
|
| Rate for Payer: Quartz Commercial |
$971.40
|
| Rate for Payer: WEA Trust Commercial |
$890.45
|
| Rate for Payer: WPS Commercial |
$1,199.19
|
|
|
LE/ABD Pelvic 3rd Order
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
3052564
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$959.56 |
| Max. Negotiated Rate |
$13,708.00 |
| Rate for Payer: Aetna Commercial |
$3,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,947.22
|
| Rate for Payer: Aetna Managed Medicare |
$959.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,227.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,713.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,644.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,816.31
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$3,152.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$3,050.03
|
| Rate for Payer: HFN Commercial |
$3,152.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,570.25
|
| Rate for Payer: Multiplan Commercial |
$2,741.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,056.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,152.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,679.23
|
| Rate for Payer: Quartz Commercial |
$2,227.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,056.20
|
| Rate for Payer: The Alliance Commercial |
$13,708.00
|
| Rate for Payer: WEA Trust Commercial |
$1,884.85
|
| Rate for Payer: WPS Commercial |
$2,538.38
|
|
|
LE/ABD Pelvic 3rd Order
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
3052564
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,679.23 |
| Max. Negotiated Rate |
$3,152.84 |
| Rate for Payer: Aetna Commercial |
$3,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,947.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,816.31
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$3,152.84
|
| Rate for Payer: Health EOS Commercial |
$3,050.03
|
| Rate for Payer: HFN Commercial |
$3,152.84
|
| Rate for Payer: Multiplan Commercial |
$2,741.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,056.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,152.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,679.23
|
| Rate for Payer: Quartz Commercial |
$2,056.20
|
| Rate for Payer: WEA Trust Commercial |
$1,884.85
|
| Rate for Payer: WPS Commercial |
$2,538.38
|
|
|
LE/ABD Pelvic Ea Add Vessel +
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
4125627
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$140.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.25
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$301.80
|
| Rate for Payer: The Alliance Commercial |
$2,012.00
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
LE/ABD Pelvic Ea Add Vessel +
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
4125627
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
LEAD INTRODUCER 7FR
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2972100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.10 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$714.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
LEAD INTRODUCER 7FR
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2972100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$333.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.92
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.50
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$773.50
|
| Rate for Payer: Quartz Medicare Advantage |
$714.00
|
| Rate for Payer: The Alliance Commercial |
$4,760.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
Lead Level
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Lead Level
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$392.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$392.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.80
|
| Rate for Payer: Health EOS Commercial |
$375.83
|
| Rate for Payer: HFN Commercial |
$392.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$392.35
|
| Rate for Payer: Quartz Beloit One Network |
$181.72
|
| Rate for Payer: Quartz Commercial |
$235.41
|
| Rate for Payer: The Alliance Commercial |
$206.50
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Lead Level
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.30
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$372.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.64
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$360.45
|
| Rate for Payer: HFN Commercial |
$372.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$372.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$198.45
|
| Rate for Payer: Quartz Commercial |
$263.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$303.75
|
| Rate for Payer: WEA Trust Commercial |
$222.75
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$299.98
|
|
|
Lead Level
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$384.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.30
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$384.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.00
|
| Rate for Payer: Health EOS Commercial |
$368.55
|
| Rate for Payer: HFN Commercial |
$384.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$384.75
|
| Rate for Payer: Quartz Beloit One Network |
$178.20
|
| Rate for Payer: Quartz Commercial |
$230.85
|
| Rate for Payer: The Alliance Commercial |
$202.50
|
| Rate for Payer: WEA Trust Commercial |
$222.75
|
| Rate for Payer: WPS Commercial |
$299.98
|
|
|
Lead Level
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.11
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$309.75
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Lead Level
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.45 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Aetna Commercial |
$364.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.65
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$372.60
|
| Rate for Payer: Health EOS Commercial |
$360.45
|
| Rate for Payer: HFN Commercial |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: NAPHCARE Commercial |
$243.00
|
| Rate for Payer: Preferred Network Access Commercial |
$372.60
|
| Rate for Payer: Quartz Beloit One Network |
$198.45
|
| Rate for Payer: Quartz Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$222.75
|
| Rate for Payer: WPS Commercial |
$299.98
|
|
|
Lead Level 24 Hour Urine
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.80
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
Lead Level 24 Hour Urine
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
Lead Level 24 Hour Urine
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
Lead Level to WSLH
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Lead Level to WSLH
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$206.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.20
|
| Rate for Payer: Health EOS Commercial |
$197.47
|
| Rate for Payer: HFN Commercial |
$206.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.15
|
| Rate for Payer: Quartz Beloit One Network |
$95.48
|
| Rate for Payer: Quartz Commercial |
$123.69
|
| Rate for Payer: The Alliance Commercial |
$108.50
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Lead Level to WSLH
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.43
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$162.75
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
LEAD PERM.INTRO. 10.5FR. 6210-S5
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
2963405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$645.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
LEAD PERM.INTRO. 10.5FR. 6210-S5
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
2963405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Aetna Managed Medicare |
$301.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$698.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$537.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$601.57
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.25
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$698.75
|
| Rate for Payer: Quartz Medicare Advantage |
$645.00
|
| Rate for Payer: The Alliance Commercial |
$4,300.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
LEAD PERM.INTRO.9FR. 6209-S5
|
Facility
|
IP
|
$1,035.00
|
|
| Hospital Charge Code |
2962953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.15 |
| Max. Negotiated Rate |
$952.20 |
| Rate for Payer: Aetna Commercial |
$931.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.55
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$952.20
|
| Rate for Payer: Health EOS Commercial |
$921.15
|
| Rate for Payer: HFN Commercial |
$952.20
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: NAPHCARE Commercial |
$621.00
|
| Rate for Payer: Preferred Network Access Commercial |
$952.20
|
| Rate for Payer: Quartz Beloit One Network |
$507.15
|
| Rate for Payer: Quartz Commercial |
$621.00
|
| Rate for Payer: WEA Trust Commercial |
$569.25
|
| Rate for Payer: WPS Commercial |
$766.62
|
|
