|
.Manual Differential
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
.Manual Differential
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
983771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Manual Irrigation of a pre-existing catheter* - Urinary Catheter Activity Type:
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
5582049
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$168.60
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Manual Irrigation of a pre-existing catheter* - Urinary Catheter Activity Type:
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
5582049
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$134.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.88
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$182.65
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$210.75
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Manual percussion
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989714
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Manual percussion
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989714
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Manual Therapy Technique, Joint Mobilization 15 Minutes
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
1188841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.29
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Manual Therapy Technique, Manual Traction 15 Minutes
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
1188842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$94.29 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.29
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
MA Post Proc Mam Marker Placement Bilat
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5551900
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$124.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.02
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$289.25
|
| Rate for Payer: Quartz Medicare Advantage |
$267.00
|
| Rate for Payer: The Alliance Commercial |
$1,780.00
|
| Rate for Payer: United Healthcare PPO |
$333.75
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
MA Post Proc Mam Marker Placement Bilat
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5551900
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.00
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: HFN Commercial |
$422.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$387.91
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: The Alliance Commercial |
$222.50
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
MA Post Proc Mam Marker Placement Bilat
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5551900
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
MA Post Proc Mam Marker Placement Left
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5551903
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$172.92 |
| Max. Negotiated Rate |
$438.07 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$373.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.80
|
| Rate for Payer: Health EOS Commercial |
$357.63
|
| Rate for Payer: HFN Commercial |
$373.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$438.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$438.07
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$373.35
|
| Rate for Payer: Quartz Beloit One Network |
$172.92
|
| Rate for Payer: Quartz Commercial |
$224.01
|
| Rate for Payer: The Alliance Commercial |
$196.50
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Post Proc Mam Marker Placement Left
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5551903
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Aetna Managed Medicare |
$110.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.92
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.75
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$255.45
|
| Rate for Payer: Quartz Medicare Advantage |
$235.80
|
| Rate for Payer: The Alliance Commercial |
$1,572.00
|
| Rate for Payer: United Healthcare PPO |
$294.75
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Post Proc Mam Marker Placement Left
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5551903
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$361.56 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$235.80
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Post Proc Mam Marker Placement Right
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5551906
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$172.92 |
| Max. Negotiated Rate |
$438.07 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$373.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.80
|
| Rate for Payer: Health EOS Commercial |
$357.63
|
| Rate for Payer: HFN Commercial |
$373.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$438.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$438.07
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$373.35
|
| Rate for Payer: Quartz Beloit One Network |
$172.92
|
| Rate for Payer: Quartz Commercial |
$224.01
|
| Rate for Payer: The Alliance Commercial |
$196.50
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Post Proc Mam Marker Placement Right
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5551906
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$361.56 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$235.80
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Post Proc Mam Marker Placement Right
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5551906
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$1,572.00 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Aetna Managed Medicare |
$110.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.29
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$361.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.92
|
| Rate for Payer: Health EOS Commercial |
$349.77
|
| Rate for Payer: HFN Commercial |
$361.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.75
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: NAPHCARE Commercial |
$235.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.56
|
| Rate for Payer: Quartz Beloit One Network |
$192.57
|
| Rate for Payer: Quartz Commercial |
$255.45
|
| Rate for Payer: Quartz Medicare Advantage |
$235.80
|
| Rate for Payer: The Alliance Commercial |
$1,572.00
|
| Rate for Payer: United Healthcare PPO |
$294.75
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
MA Radiological Specimen
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
630705
|
| Min. Negotiated Rate |
$182.88 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$247.65
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Radiological Specimen
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
1268833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
MA Radiological Specimen
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
1268833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,044.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,554.05
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
MA Radiological Specimen
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
630705
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna Commercial |
$361.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$361.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.60
|
| Rate for Payer: Health EOS Commercial |
$346.71
|
| Rate for Payer: HFN Commercial |
$361.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.95
|
| Rate for Payer: Quartz Beloit One Network |
$167.64
|
| Rate for Payer: Quartz Commercial |
$217.17
|
| Rate for Payer: The Alliance Commercial |
$190.50
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Radiological Specimen
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
1268833
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
MA Radiological Specimen
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
630705
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$228.60
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
Marfan and Related Genetic Panel to Mayo
|
Professional
|
Both
|
$4,404.00
|
|
|
Service Code
|
CPT 81410
|
| Hospital Charge Code |
5322768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,779.12 |
| Max. Negotiated Rate |
$4,183.80 |
| Rate for Payer: Aetna Commercial |
$4,183.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,183.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,202.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,642.40
|
| Rate for Payer: Health EOS Commercial |
$4,007.64
|
| Rate for Payer: HFN Commercial |
$4,183.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,779.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,779.12
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,183.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,937.76
|
| Rate for Payer: Quartz Commercial |
$2,510.28
|
| Rate for Payer: The Alliance Commercial |
$2,202.00
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
|
Marfan and Related Genetic Panel to Mayo
|
Facility
|
OP
|
$4,404.00
|
|
|
Service Code
|
CPT 81410
|
| Hospital Charge Code |
5322768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$4,051.68 |
| Rate for Payer: Aetna Commercial |
$3,963.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,787.44
|
| Rate for Payer: Aetna Managed Medicare |
$504.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,890.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$882.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$836.64
|
| Rate for Payer: Anthem Medicaid |
$504.00
|
| Rate for Payer: Anthem Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,334.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$504.00
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cigna Commercial |
$4,051.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$504.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,464.48
|
| Rate for Payer: Dean Health Medicaid |
$504.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$504.00
|
| Rate for Payer: Health EOS Commercial |
$3,919.56
|
| Rate for Payer: HFN Commercial |
$4,051.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,874.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$504.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$504.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$504.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$3,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$756.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,051.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$504.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.96
|
| Rate for Payer: Quartz Commercial |
$2,862.60
|
| Rate for Payer: Quartz Medicare Advantage |
$504.00
|
| Rate for Payer: The Alliance Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare Medicaid |
$504.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$504.00
|
| Rate for Payer: United Healthcare PPO |
$3,303.00
|
| Rate for Payer: WEA Trust Commercial |
$2,422.20
|
| Rate for Payer: Wellcare Medicare |
$504.00
|
| Rate for Payer: WMAP Medicaid |
$504.00
|
| Rate for Payer: WPS Commercial |
$3,262.04
|
|
