|
MRSA, PCR - Nares
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.84 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.60
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: HFN Commercial |
$129.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
MRSA, PCR - Nares
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.11
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
MRSA-SA, PCR - SSTI
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$279.68 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$279.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.12
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$270.56
|
| Rate for Payer: HFN Commercial |
$279.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$279.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$148.96
|
| Rate for Payer: Quartz Commercial |
$197.60
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$225.17
|
|
|
MRSA-SA, PCR - SSTI
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.40
|
| Rate for Payer: Health EOS Commercial |
$276.64
|
| Rate for Payer: HFN Commercial |
$288.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$288.80
|
| Rate for Payer: Quartz Beloit One Network |
$133.76
|
| Rate for Payer: Quartz Commercial |
$173.28
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$225.17
|
|
|
MRSA-SA, PCR - SSTI
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$279.68 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.12
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$279.68
|
| Rate for Payer: Health EOS Commercial |
$270.56
|
| Rate for Payer: HFN Commercial |
$279.68
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: NAPHCARE Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$279.68
|
| Rate for Payer: Quartz Beloit One Network |
$148.96
|
| Rate for Payer: Quartz Commercial |
$182.40
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$225.17
|
|
|
MRV Head Venous Angiogram w/o
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
1611408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRV Head Venous Angiogram w/o
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
1611408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,402.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,790.45
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Professional
|
Both
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$613.37 |
| Max. Negotiated Rate |
$4,078.35 |
| Rate for Payer: Aetna Commercial |
$4,078.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,078.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.80
|
| Rate for Payer: Health EOS Commercial |
$3,906.63
|
| Rate for Payer: HFN Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$613.37
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,078.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.92
|
| Rate for Payer: Quartz Commercial |
$2,447.01
|
| Rate for Payer: The Alliance Commercial |
$2,146.50
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,103.57 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.29
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,575.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,575.80
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRV Head Venous Angiogram w+ w/o
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
1611405
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,999.29 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,672.60
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
MRV Head Venous Angiogram w+ w/o
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
1611405
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,425.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,978.65
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
MRV Head Venous Angiogram w + w/o Contrast
|
Professional
|
Both
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
5288676
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$994.68 |
| Max. Negotiated Rate |
$5,814.95 |
| Rate for Payer: Aetna Commercial |
$5,814.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,814.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,060.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,672.60
|
| Rate for Payer: Health EOS Commercial |
$5,570.11
|
| Rate for Payer: HFN Commercial |
$5,814.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$994.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$994.68
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,693.24
|
| Rate for Payer: Quartz Commercial |
$3,488.97
|
| Rate for Payer: The Alliance Commercial |
$3,060.50
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
MRV Head Venous Angiogram w + w/o Contrast
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
5288676
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,999.29 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,672.60
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
MRV Head Venous Angiogram w + w/o Contrast
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
5288676
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,631.32 |
| Rate for Payer: Aetna Commercial |
$5,508.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,264.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,244.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,631.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,425.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,447.69
|
| Rate for Payer: HFN Commercial |
$5,631.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,896.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,631.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.29
|
| Rate for Payer: Quartz Commercial |
$3,978.65
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,366.55
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,533.82
|
|
|
MSH6
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81298
|
| Hospital Charge Code |
5542925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.26 |
| Max. Negotiated Rate |
$2,567.40 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$641.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,406.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,123.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.47
|
| Rate for Payer: Anthem Medicaid |
$230.26
|
| Rate for Payer: Anthem Medicare Advantage |
$641.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$641.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$641.85
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$641.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Dean Health Medicaid |
$230.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$641.85
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,387.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$230.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$641.85
|
| Rate for Payer: Managed Health Services Medicaid |
$239.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$641.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$641.85
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$962.78
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$230.26
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$641.85
|
| Rate for Payer: The Alliance Commercial |
$2,567.40
|
| Rate for Payer: United Healthcare Medicaid |
$230.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$641.85
|
| Rate for Payer: United Healthcare PPO |
$501.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: Wellcare Medicare |
$641.85
|
| Rate for Payer: WMAP Medicaid |
$230.26
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSH6
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81298
|
| Hospital Charge Code |
5542925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.92 |
| Max. Negotiated Rate |
$2,265.73 |
| Rate for Payer: Aetna Commercial |
$634.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$634.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.80
|
| Rate for Payer: Health EOS Commercial |
$607.88
|
| Rate for Payer: HFN Commercial |
$634.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,265.73
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$634.60
|
| Rate for Payer: Quartz Beloit One Network |
$293.92
|
| Rate for Payer: Quartz Commercial |
$380.76
|
| Rate for Payer: The Alliance Commercial |
$334.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSH6
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81298
|
| Hospital Charge Code |
5542925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSH6 Dup/Del
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81300
|
| Hospital Charge Code |
5542926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.92 |
| Max. Negotiated Rate |
$840.14 |
| Rate for Payer: Aetna Commercial |
$634.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$634.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.80
|
| Rate for Payer: Health EOS Commercial |
$607.88
|
| Rate for Payer: HFN Commercial |
$634.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$840.14
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$634.60
|
| Rate for Payer: Quartz Beloit One Network |
$293.92
|
| Rate for Payer: Quartz Commercial |
$380.76
|
| Rate for Payer: The Alliance Commercial |
$334.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSH6 Dup/Del
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81300
|
| Hospital Charge Code |
5542926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$238.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$395.08
|
| Rate for Payer: Anthem Medicaid |
$129.34
|
| Rate for Payer: Anthem Medicare Advantage |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.00
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$238.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Dean Health Medicaid |
$129.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$238.00
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$238.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$357.00
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.34
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$238.00
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.00
|
| Rate for Payer: United Healthcare PPO |
$501.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: Wellcare Medicare |
$238.00
|
| Rate for Payer: WMAP Medicaid |
$129.34
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSH6 Dup/Del
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81300
|
| Hospital Charge Code |
5542926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
MSSA BC PCR
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5239044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
MSSA BC PCR
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5239044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
MSSA BC PCR
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5239044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
MTHFR DNA Mutation Analysis
|
Facility
|
IP
|
$1,304.00
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
983331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$638.96 |
| Max. Negotiated Rate |
$1,199.68 |
| Rate for Payer: HFN Commercial |
$1,199.68
|
| Rate for Payer: Multiplan Commercial |
$1,043.20
|
| Rate for Payer: NAPHCARE Commercial |
$782.40
|
| Rate for Payer: Aetna Commercial |
$1,173.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,121.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.12
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cigna Commercial |
$1,199.68
|
| Rate for Payer: Health EOS Commercial |
$1,160.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,199.68
|
| Rate for Payer: Quartz Beloit One Network |
$638.96
|
| Rate for Payer: Quartz Commercial |
$782.40
|
| Rate for Payer: WEA Trust Commercial |
$717.20
|
| Rate for Payer: WPS Commercial |
$965.87
|
|
