|
Myeloperoxidase Antibody
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
2942859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$159.54
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$64,402.00
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$18,206.41 |
| Max. Negotiated Rate |
$64,402.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,206.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,428.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,653.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,722.93
|
| Rate for Payer: Anthem Medicare Advantage |
$18,206.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,206.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,206.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,206.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,765.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,206.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,992.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,206.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,206.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,206.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,206.41
|
| Rate for Payer: NAPHCARE Commercial |
$27,309.61
|
| Rate for Payer: Quartz Medicare Advantage |
$18,206.41
|
| Rate for Payer: The Alliance Commercial |
$64,402.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,206.41
|
| Rate for Payer: United Healthcare PPO |
$36,584.51
|
| Rate for Payer: Wellcare Medicare |
$18,206.41
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$128,286.08
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$36,330.29 |
| Max. Negotiated Rate |
$128,286.08 |
| Rate for Payer: Aetna Managed Medicare |
$36,330.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102,065.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78,232.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74,326.13
|
| Rate for Payer: Anthem Medicare Advantage |
$36,330.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,330.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,330.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,330.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82,508.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,330.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89,004.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,330.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,330.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,330.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,330.29
|
| Rate for Payer: NAPHCARE Commercial |
$54,495.43
|
| Rate for Payer: Quartz Medicare Advantage |
$36,330.29
|
| Rate for Payer: The Alliance Commercial |
$128,286.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,330.29
|
| Rate for Payer: United Healthcare PPO |
$69,291.42
|
| Rate for Payer: Wellcare Medicare |
$36,330.29
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$45,689.28
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$13,554.81 |
| Max. Negotiated Rate |
$45,689.28 |
| Rate for Payer: Aetna Managed Medicare |
$13,554.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,175.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,494.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,071.88
|
| Rate for Payer: Anthem Medicare Advantage |
$13,554.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,554.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,554.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,554.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,052.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,554.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,267.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,554.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,554.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,554.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,554.81
|
| Rate for Payer: NAPHCARE Commercial |
$20,332.21
|
| Rate for Payer: Quartz Medicare Advantage |
$13,554.81
|
| Rate for Payer: The Alliance Commercial |
$45,689.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,554.81
|
| Rate for Payer: United Healthcare PPO |
$25,899.03
|
| Rate for Payer: Wellcare Medicare |
$13,554.81
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$87,533.68
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$24,706.68 |
| Max. Negotiated Rate |
$87,533.68 |
| Rate for Payer: Aetna Managed Medicare |
$24,706.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68,948.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,848.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,209.62
|
| Rate for Payer: Anthem Medicare Advantage |
$24,706.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,706.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,706.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,706.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55,737.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,706.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,959.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,706.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,706.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,706.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,706.68
|
| Rate for Payer: NAPHCARE Commercial |
$37,060.02
|
| Rate for Payer: Quartz Medicare Advantage |
$24,706.68
|
| Rate for Payer: The Alliance Commercial |
$87,533.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,706.68
|
| Rate for Payer: United Healthcare PPO |
$49,792.95
|
| Rate for Payer: Wellcare Medicare |
$24,706.68
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,052.32
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$12,032.36 |
| Max. Negotiated Rate |
$44,052.32 |
| Rate for Payer: Aetna Managed Medicare |
$12,032.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,837.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,169.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,913.13
|
| Rate for Payer: Anthem Medicare Advantage |
$12,032.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,032.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,032.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,032.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,545.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,032.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,066.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,032.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,032.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,032.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,032.36
|
| Rate for Payer: NAPHCARE Commercial |
$18,048.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12,032.36
|
| Rate for Payer: The Alliance Commercial |
$44,052.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,032.36
|
| Rate for Payer: United Healthcare PPO |
$24,964.37
|
| Rate for Payer: Wellcare Medicare |
$12,032.36
|
|
|
MYH Gene Analysis
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4602759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$626.91 |
| Rate for Payer: Aetna Commercial |
$351.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$351.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$351.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$351.73
|
| Rate for Payer: Quartz Beloit One Network |
$162.91
|
| Rate for Payer: Quartz Commercial |
$211.04
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
MYH Gene Analysis
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4602759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$569.92 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
MYH Gene Analysis
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
4602759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
MYLICON WHITE W/BLCK LTR #ANW
|
Facility
|
OP
|
$202.00
|
|
| Hospital Charge Code |
2974885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Aetna Managed Medicare |
$58.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.56
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.56
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$126.05
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$136.55
|
| Rate for Payer: Quartz Medicare Advantage |
$126.05
|
| Rate for Payer: The Alliance Commercial |
$105.04
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
MYLICON WHITE W/BLCK LTR #ANW
|
Facility
|
IP
|
$202.00
|
|
| Hospital Charge Code |
2974885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$126.05
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
Myocardial Perfusion Planar Multiple Studies 7845426
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
CPT 78454 26
|
| Hospital Charge Code |
4494936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$1,178.68 |
| Rate for Payer: Aetna Commercial |
$1,178.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,067.02
|
| Rate for Payer: Aetna Managed Medicare |
$61.22
|
| Rate for Payer: Anthem Medicare Advantage |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.22
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,178.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.22
|
| Rate for Payer: Health EOS Commercial |
$1,129.06
|
| Rate for Payer: HFN Commercial |
$1,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.22
|
| Rate for Payer: Multiplan Commercial |
$992.58
|
| Rate for Payer: NAPHCARE Commercial |
$91.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$545.92
|
| Rate for Payer: Quartz Commercial |
$707.21
|
| Rate for Payer: Quartz Medicare Advantage |
$61.22
|
| Rate for Payer: The Alliance Commercial |
$232.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.22
|
| Rate for Payer: WEA Trust Commercial |
$682.40
|
| Rate for Payer: WPS Commercial |
$306.12
|
|
|
MYOCUTANEOUS ADV FLAP FOR VENTRAL HERNIA
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
MYOCUTANEOUS ADV FLAP FOR VENTRAL HERNIA
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Myoglobin
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
633786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$260.83 |
| Rate for Payer: Aetna Commercial |
$260.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$260.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$249.85
|
| Rate for Payer: HFN Commercial |
$260.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$20.16
|
| Rate for Payer: Preferred Network Access Commercial |
$260.83
|
| Rate for Payer: Quartz Beloit One Network |
$120.81
|
| Rate for Payer: Quartz Commercial |
$156.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$59.12
|
|
|
Myoglobin
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
633786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$164.74
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
Myoglobin
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
633786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.31
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$20.16
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$53.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare PPO |
$205.92
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: Wellcare Medicare |
$13.44
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
Myoglobin Urine
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.31
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.16
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$53.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare PPO |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: Wellcare Medicare |
$13.44
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
Myoglobin Urine
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.16
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$59.12
|
|
|
Myoglobin Urine
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
Myositis AssessR
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$132.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$126.82
|
| Rate for Payer: HFN Commercial |
$132.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$132.39
|
| Rate for Payer: Quartz Beloit One Network |
$61.32
|
| Rate for Payer: Quartz Commercial |
$79.44
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
Myositis AssessR
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$104.52
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Myositis AssessR
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
MYO Spect Ex/Rest 7845226
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
CPT 78452 26
|
| Hospital Charge Code |
3133503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.16 |
| Max. Negotiated Rate |
$1,315.03 |
| Rate for Payer: Aetna Commercial |
$1,315.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,190.45
|
| Rate for Payer: Aetna Managed Medicare |
$75.16
|
| Rate for Payer: Anthem Medicare Advantage |
$75.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.16
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,315.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$692.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.16
|
| Rate for Payer: Health EOS Commercial |
$1,259.66
|
| Rate for Payer: HFN Commercial |
$1,315.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$276.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.16
|
| Rate for Payer: Multiplan Commercial |
$1,107.39
|
| Rate for Payer: NAPHCARE Commercial |
$112.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,315.03
|
| Rate for Payer: Quartz Beloit One Network |
$609.07
|
| Rate for Payer: Quartz Commercial |
$789.02
|
| Rate for Payer: Quartz Medicare Advantage |
$75.16
|
| Rate for Payer: The Alliance Commercial |
$285.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.16
|
| Rate for Payer: WEA Trust Commercial |
$761.33
|
| Rate for Payer: WPS Commercial |
$375.80
|
|
