|
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 |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
LEAD INTRODUCER 7FR
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
2972100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
LEAD INTRODUCER 7FR
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
2972100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Aetna Managed Medicare |
$346.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.58
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.20
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: NAPHCARE Commercial |
$742.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$804.44
|
| Rate for Payer: Quartz Medicare Advantage |
$742.56
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
Lead Level
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$400.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$400.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$383.29
|
| Rate for Payer: HFN Commercial |
$400.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$400.14
|
| Rate for Payer: Quartz Beloit One Network |
$185.33
|
| Rate for Payer: Quartz Commercial |
$240.08
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$49.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$55.42
|
|
|
Lead Level
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$408.04 |
| Rate for Payer: Aetna Commercial |
$408.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$408.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$390.86
|
| Rate for Payer: HFN Commercial |
$408.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$408.04
|
| Rate for Payer: Quartz Beloit One Network |
$188.99
|
| Rate for Payer: Quartz Commercial |
$244.83
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$49.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$55.42
|
|
|
Lead Level
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$50.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: United Healthcare PPO |
$322.14
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: Wellcare Medicare |
$12.59
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
Lead Level
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942904
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
Lead Level
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Lead Level
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
633774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$273.78
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$50.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: United Healthcare PPO |
$315.90
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: Wellcare Medicare |
$12.59
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Lead Level 24 Hour Urine
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$140.61
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$50.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: United Healthcare PPO |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: Wellcare Medicare |
$12.59
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
Lead Level 24 Hour Urine
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$196.85
|
| Rate for Payer: HFN Commercial |
$205.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$205.50
|
| Rate for Payer: Quartz Beloit One Network |
$95.18
|
| Rate for Payer: Quartz Commercial |
$123.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$49.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$55.42
|
|
|
Lead Level 24 Hour Urine
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
978126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
Lead Level to WSLH
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Lead Level to WSLH
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$50.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: United Healthcare PPO |
$169.26
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$12.59
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Lead Level to WSLH
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
1040875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$214.40 |
| Rate for Payer: Aetna Commercial |
$214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.59
|
| Rate for Payer: Anthem Medicare Advantage |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.59
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.59
|
| Rate for Payer: Health EOS Commercial |
$205.37
|
| Rate for Payer: HFN Commercial |
$214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.59
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.89
|
| Rate for Payer: Preferred Network Access Commercial |
$214.40
|
| Rate for Payer: Quartz Beloit One Network |
$99.30
|
| Rate for Payer: Quartz Commercial |
$128.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12.59
|
| Rate for Payer: The Alliance Commercial |
$49.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.59
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$55.42
|
|
|
LEAD PERM.INTRO. 10.5FR. 6210-S5
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
2963405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,028.56 |
| Rate for Payer: Aetna Commercial |
$1,006.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Aetna Managed Medicare |
$313.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$559.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.54
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,028.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.65
|
| Rate for Payer: Health EOS Commercial |
$995.02
|
| Rate for Payer: HFN Commercial |
$1,028.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.50
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: NAPHCARE Commercial |
$670.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.56
|
| Rate for Payer: Quartz Beloit One Network |
$547.82
|
| Rate for Payer: Quartz Commercial |
$726.70
|
| Rate for Payer: Quartz Medicare Advantage |
$670.80
|
| Rate for Payer: The Alliance Commercial |
$559.00
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$828.07
|
|
|
LEAD PERM.INTRO. 10.5FR. 6210-S5
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
2963405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$1,028.56 |
| Rate for Payer: Aetna Commercial |
$1,006.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.54
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,028.56
|
| Rate for Payer: Health EOS Commercial |
$995.02
|
| Rate for Payer: HFN Commercial |
$1,028.56
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.56
|
| Rate for Payer: Quartz Beloit One Network |
$547.82
|
| Rate for Payer: Quartz Commercial |
$670.80
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$828.07
|
|
|
LEAD PERM.INTRO.9FR. 6209-S5
|
Facility
|
IP
|
$1,035.00
|
|
| Hospital Charge Code |
2962953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.44 |
| Max. Negotiated Rate |
$990.29 |
| Rate for Payer: Aetna Commercial |
$968.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$925.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.49
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$990.29
|
| Rate for Payer: Health EOS Commercial |
$958.00
|
| Rate for Payer: HFN Commercial |
$990.29
|
| Rate for Payer: Multiplan Commercial |
$861.12
|
| Rate for Payer: Preferred Network Access Commercial |
$990.29
|
| Rate for Payer: Quartz Beloit One Network |
$527.44
|
| Rate for Payer: Quartz Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$592.02
|
| Rate for Payer: WPS Commercial |
$797.26
|
|
|
LEAD PERM.INTRO.9FR. 6209-S5
|
Facility
|
OP
|
$1,035.00
|
|
| Hospital Charge Code |
2962953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.39 |
| Max. Negotiated Rate |
$990.29 |
| Rate for Payer: Aetna Commercial |
$968.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$925.70
|
| Rate for Payer: Aetna Managed Medicare |
$301.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$699.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$538.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$570.49
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$990.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.37
|
| Rate for Payer: Health EOS Commercial |
$958.00
|
| Rate for Payer: HFN Commercial |
$990.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.30
|
| Rate for Payer: Multiplan Commercial |
$861.12
|
| Rate for Payer: NAPHCARE Commercial |
$645.84
|
| Rate for Payer: Preferred Network Access Commercial |
$990.29
|
| Rate for Payer: Quartz Beloit One Network |
$527.44
|
| Rate for Payer: Quartz Commercial |
$699.66
|
| Rate for Payer: Quartz Medicare Advantage |
$645.84
|
| Rate for Payer: The Alliance Commercial |
$538.20
|
| Rate for Payer: WEA Trust Commercial |
$592.02
|
| Rate for Payer: WPS Commercial |
$797.26
|
|
|
LEAD SINGLE PIN #304-20
|
Facility
|
OP
|
$33,571.00
|
|
| Hospital Charge Code |
2965002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,775.88 |
| Max. Negotiated Rate |
$32,120.73 |
| Rate for Payer: Aetna Commercial |
$31,422.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,025.90
|
| Rate for Payer: Aetna Managed Medicare |
$9,775.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,694.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,456.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,758.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,504.34
|
| Rate for Payer: Cash Price |
$10,071.30
|
| Rate for Payer: Cigna Commercial |
$32,120.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,538.32
|
| Rate for Payer: Health EOS Commercial |
$31,073.32
|
| Rate for Payer: HFN Commercial |
$32,120.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,185.38
|
| Rate for Payer: Multiplan Commercial |
$27,931.07
|
| Rate for Payer: NAPHCARE Commercial |
$20,948.30
|
| Rate for Payer: Preferred Network Access Commercial |
$32,120.73
|
| Rate for Payer: Quartz Beloit One Network |
$17,107.78
|
| Rate for Payer: Quartz Commercial |
$22,694.00
|
| Rate for Payer: Quartz Medicare Advantage |
$20,948.30
|
| Rate for Payer: The Alliance Commercial |
$17,456.92
|
| Rate for Payer: WEA Trust Commercial |
$19,202.61
|
| Rate for Payer: WPS Commercial |
$25,859.74
|
|
|
LEAD SINGLE PIN #304-20
|
Facility
|
IP
|
$33,571.00
|
|
| Hospital Charge Code |
2965002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,107.78 |
| Max. Negotiated Rate |
$32,120.73 |
| Rate for Payer: Aetna Commercial |
$31,422.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,025.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,504.34
|
| Rate for Payer: Cash Price |
$10,071.30
|
| Rate for Payer: Cigna Commercial |
$32,120.73
|
| Rate for Payer: Health EOS Commercial |
$31,073.32
|
| Rate for Payer: HFN Commercial |
$32,120.73
|
| Rate for Payer: Multiplan Commercial |
$27,931.07
|
| Rate for Payer: Preferred Network Access Commercial |
$32,120.73
|
| Rate for Payer: Quartz Beloit One Network |
$17,107.78
|
| Rate for Payer: Quartz Commercial |
$20,948.30
|
| Rate for Payer: WEA Trust Commercial |
$19,202.61
|
| Rate for Payer: WPS Commercial |
$25,859.74
|
|
|
Least Incompatible - Crossmatch AHG Interpretation
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2952715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Least Incompatible - Crossmatch AHG Interpretation
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
2952715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| 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 |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Least Incompatible - Crossmatch Immediate Spin Interpretation
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2952719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| 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 |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$73.32
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Least Incompatible - Crossmatch Immediate Spin Interpretation
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
2952719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
