|
POLY INSERT INFINITY EVERLAST CROSS-LINK SZ 2+ H 10MM 33683210
|
Facility
|
OP
|
$18,871.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,283.88 |
| Max. Negotiated Rate |
$75,484.00 |
| Rate for Payer: Aetna Commercial |
$16,983.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,229.06
|
| Rate for Payer: Aetna Managed Medicare |
$5,283.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,266.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,435.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,058.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,001.63
|
| Rate for Payer: Cash Price |
$5,661.30
|
| Rate for Payer: Cigna Commercial |
$17,361.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,560.21
|
| Rate for Payer: Health EOS Commercial |
$16,795.19
|
| Rate for Payer: HFN Commercial |
$17,361.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,153.25
|
| Rate for Payer: Multiplan Commercial |
$15,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$11,322.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17,361.32
|
| Rate for Payer: Quartz Beloit One Network |
$9,246.79
|
| Rate for Payer: Quartz Commercial |
$12,266.15
|
| Rate for Payer: Quartz Medicare Advantage |
$11,322.60
|
| Rate for Payer: The Alliance Commercial |
$75,484.00
|
| Rate for Payer: WEA Trust Commercial |
$10,379.05
|
| Rate for Payer: WPS Commercial |
$13,977.75
|
|
|
POLYPECTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
POLYPECTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Polysomnogram
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
3103324
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,430.00 |
| Max. Negotiated Rate |
$6,440.00 |
| Rate for Payer: Aetna Commercial |
$6,300.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,710.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$6,440.00
|
| Rate for Payer: Health EOS Commercial |
$6,230.00
|
| Rate for Payer: HFN Commercial |
$6,440.00
|
| Rate for Payer: Multiplan Commercial |
$5,600.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,440.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,430.00
|
| Rate for Payer: Quartz Commercial |
$4,200.00
|
| Rate for Payer: WEA Trust Commercial |
$3,850.00
|
| Rate for Payer: WPS Commercial |
$5,184.90
|
|
|
Polysomnogram
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
3103324
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$6,440.00 |
| Rate for Payer: Aetna Commercial |
$6,300.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,020.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,710.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$6,440.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,917.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,230.00
|
| Rate for Payer: HFN Commercial |
$6,440.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$5,600.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$6,440.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,430.00
|
| Rate for Payer: Quartz Commercial |
$4,550.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,250.00
|
| Rate for Payer: WEA Trust Commercial |
$3,850.00
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,184.90
|
|
|
Polysomnogram CPAP - Sleep Test
|
Facility
|
IP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526804
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,106.20 |
| Max. Negotiated Rate |
$7,709.60 |
| Rate for Payer: Aetna Commercial |
$7,542.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,206.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,441.40
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$7,709.60
|
| Rate for Payer: Health EOS Commercial |
$7,458.20
|
| Rate for Payer: HFN Commercial |
$7,709.60
|
| Rate for Payer: Multiplan Commercial |
$6,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,028.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,709.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,106.20
|
| Rate for Payer: Quartz Commercial |
$5,028.00
|
| Rate for Payer: WEA Trust Commercial |
$4,609.00
|
| Rate for Payer: WPS Commercial |
$6,207.07
|
|
|
Polysomnogram CPAP - Sleep Test
|
Facility
|
OP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526804
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,709.60 |
| Rate for Payer: Aetna Commercial |
$7,542.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,206.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,441.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$7,709.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,689.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$7,458.20
|
| Rate for Payer: HFN Commercial |
$7,709.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,709.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,106.20
|
| Rate for Payer: Quartz Commercial |
$5,447.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$6,285.00
|
| Rate for Payer: WEA Trust Commercial |
$4,609.00
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$6,207.07
|
|
|
Polysomnogram CPAP With Titration - Sleep Test
|
Facility
|
IP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,106.20 |
| Max. Negotiated Rate |
$7,709.60 |
| Rate for Payer: Aetna Commercial |
$7,542.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,206.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,441.40
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$7,709.60
|
| Rate for Payer: Health EOS Commercial |
$7,458.20
|
| Rate for Payer: HFN Commercial |
$7,709.60
|
| Rate for Payer: Multiplan Commercial |
$6,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,028.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,709.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,106.20
|
| Rate for Payer: Quartz Commercial |
$5,028.00
|
| Rate for Payer: WEA Trust Commercial |
$4,609.00
|
| Rate for Payer: WPS Commercial |
$6,207.07
|
|
|
Polysomnogram CPAP With Titration - Sleep Test
|
Facility
|
OP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,709.60 |
| Rate for Payer: Aetna Commercial |
$7,542.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,206.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,441.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$7,709.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,689.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$7,458.20
|
| Rate for Payer: HFN Commercial |
$7,709.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,709.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,106.20
|
| Rate for Payer: Quartz Commercial |
$5,447.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$6,285.00
|
| Rate for Payer: WEA Trust Commercial |
$4,609.00
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$6,207.07
|
|
|
Polysomnogram - Sleep Test
|
Facility
|
OP
|
$7,737.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1526803
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,118.04 |
| Rate for Payer: Aetna Commercial |
$6,963.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,653.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,100.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cigna Commercial |
$7,118.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,329.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,885.93
|
| Rate for Payer: HFN Commercial |
$7,118.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,118.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,791.13
|
| Rate for Payer: Quartz Commercial |
$5,029.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,802.75
|
| Rate for Payer: WEA Trust Commercial |
$4,255.35
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,730.80
|
|
|
Polysomnogram - Sleep Test
|
Facility
|
IP
|
$7,737.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1526803
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,791.13 |
| Max. Negotiated Rate |
$7,118.04 |
| Rate for Payer: Aetna Commercial |
$6,963.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,653.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,100.61
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cigna Commercial |
$7,118.04
|
| Rate for Payer: Health EOS Commercial |
$6,885.93
|
| Rate for Payer: HFN Commercial |
$7,118.04
|
| Rate for Payer: Multiplan Commercial |
$6,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,642.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,118.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,791.13
|
| Rate for Payer: Quartz Commercial |
$4,642.20
|
| Rate for Payer: WEA Trust Commercial |
$4,255.35
|
| Rate for Payer: WPS Commercial |
$5,730.80
|
|
|
Polysomnogram With CPAP
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103326
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,757.32 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,600.80
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
Polysomnogram With CPAP
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103326
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,291.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,984.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,751.00
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
POLYSOMNOGRAPHY, 4 OR MORE 9581026
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
CPT 95810 26
|
| Hospital Charge Code |
3015464
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$414.49 |
| Max. Negotiated Rate |
$1,907.60 |
| Rate for Payer: Aetna Commercial |
$1,907.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,726.88
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$1,907.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,204.80
|
| Rate for Payer: Health EOS Commercial |
$1,827.28
|
| Rate for Payer: HFN Commercial |
$1,907.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$414.49
|
| Rate for Payer: Multiplan Commercial |
$1,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,907.60
|
| Rate for Payer: Quartz Beloit One Network |
$883.52
|
| Rate for Payer: Quartz Commercial |
$1,144.56
|
| Rate for Payer: The Alliance Commercial |
$1,004.00
|
| Rate for Payer: United Healthcare Medicaid |
$600.33
|
| Rate for Payer: WEA Trust Commercial |
$1,104.40
|
| Rate for Payer: WPS Commercial |
$1,487.33
|
|
|
Pooled Cryo AHF
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052824
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$531.76 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Aetna Managed Medicare |
$62.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.44
|
| Rate for Payer: Anthem Medicare Advantage |
$62.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.11
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.11
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.11
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$93.16
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$375.70
|
| Rate for Payer: Quartz Medicare Advantage |
$62.11
|
| Rate for Payer: The Alliance Commercial |
$248.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.11
|
| Rate for Payer: United Healthcare PPO |
$433.50
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: Wellcare Medicare |
$62.11
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
Pooled Cryo AHF
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052824
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$283.22 |
| Max. Negotiated Rate |
$531.76 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$346.80
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$346.80
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Commercial |
$316.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$316.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.80
|
| Rate for Payer: Health EOS Commercial |
$303.03
|
| Rate for Payer: HFN Commercial |
$316.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.35
|
| Rate for Payer: Quartz Beloit One Network |
$146.52
|
| Rate for Payer: Quartz Commercial |
$189.81
|
| Rate for Payer: The Alliance Commercial |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.01
|
| Rate for Payer: Anthem Medicaid |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Dean Health Medicaid |
$8.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.66
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.72
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$33.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare PPO |
$249.75
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
| Rate for Payer: WMAP Medicaid |
$8.72
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Porphobilinogen, Quant, Random Urine
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.20
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: The Alliance Commercial |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.01
|
| Rate for Payer: Anthem Medicaid |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Dean Health Medicaid |
$8.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.66
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.72
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$33.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
| Rate for Payer: WMAP Medicaid |
$8.72
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphyrins, Fractionated, Plasma
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$401.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.80
|
| Rate for Payer: Health EOS Commercial |
$384.93
|
| Rate for Payer: HFN Commercial |
$401.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$401.85
|
| Rate for Payer: Quartz Beloit One Network |
$186.12
|
| Rate for Payer: Quartz Commercial |
$241.11
|
| Rate for Payer: The Alliance Commercial |
$211.50
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.71
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$274.95
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$317.25
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.80
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$253.80
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
