|
Risperidone
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
983393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.00
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: HFN Commercial |
$223.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: The Alliance Commercial |
$117.50
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Ristocetin Cofactor
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$312.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$312.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.40
|
| Rate for Payer: Health EOS Commercial |
$299.39
|
| Rate for Payer: HFN Commercial |
$312.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$312.55
|
| Rate for Payer: Quartz Beloit One Network |
$144.76
|
| Rate for Payer: Quartz Commercial |
$187.53
|
| Rate for Payer: The Alliance Commercial |
$164.50
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Ristocetin Cofactor
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$197.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Ristocetin Cofactor
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
983394
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.08
|
| Rate for Payer: Anthem Medicaid |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.94
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.11
|
| Rate for Payer: Dean Health Medicaid |
$23.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.94
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.94
|
| Rate for Payer: Managed Health Services Medicaid |
$24.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$34.41
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.70
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$22.94
|
| Rate for Payer: The Alliance Commercial |
$91.76
|
| Rate for Payer: United Healthcare Medicaid |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.94
|
| Rate for Payer: United Healthcare PPO |
$246.75
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$22.94
|
| Rate for Payer: WMAP Medicaid |
$23.70
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Rituximab 10mg Injection J9312
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Rituximab 10mg Injection J9312
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$316.79 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$79.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Anthem Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.20
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$79.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$79.20
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$79.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$118.80
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$79.20
|
| Rate for Payer: The Alliance Commercial |
$316.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$79.20
|
| Rate for Payer: WPS Commercial |
$197.18
|
|
|
Rituximab 10mg Injection J9312
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
5462732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.87 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.87
|
| Rate for Payer: Health EOS Commercial |
$246.61
|
| Rate for Payer: HFN Commercial |
$257.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.14
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.45
|
| Rate for Payer: Quartz Beloit One Network |
$119.24
|
| Rate for Payer: Quartz Commercial |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$135.50
|
| Rate for Payer: United Healthcare Medicaid |
$78.87
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$197.18
|
|
|
RLHC Coronaries BPG w/wo LV
|
Facility
|
IP
|
$23,908.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
3052501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,714.92 |
| Max. Negotiated Rate |
$21,995.36 |
| Rate for Payer: Aetna Commercial |
$21,517.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,560.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,671.24
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cigna Commercial |
$21,995.36
|
| Rate for Payer: Health EOS Commercial |
$21,278.12
|
| Rate for Payer: HFN Commercial |
$21,995.36
|
| Rate for Payer: Multiplan Commercial |
$19,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21,995.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,714.92
|
| Rate for Payer: Quartz Commercial |
$14,344.80
|
| Rate for Payer: WEA Trust Commercial |
$13,149.40
|
| Rate for Payer: WPS Commercial |
$17,708.66
|
|
|
RLHC Coronaries BPG w/wo LV
|
Facility
|
OP
|
$23,908.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
3052501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$21,995.36 |
| Rate for Payer: Aetna Commercial |
$21,517.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,560.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,671.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cash Price |
$7,172.40
|
| Rate for Payer: Cigna Commercial |
$21,995.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$21,278.12
|
| Rate for Payer: HFN Commercial |
$21,995.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$19,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$21,995.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,714.92
|
| Rate for Payer: Quartz Commercial |
$15,540.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$13,149.40
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$17,708.66
|
|
|
RLHC Coronaries w/wo LV
|
Facility
|
OP
|
$22,299.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
3052500
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$20,515.08 |
| Rate for Payer: Aetna Commercial |
$20,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,177.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,818.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cigna Commercial |
$20,515.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$19,846.11
|
| Rate for Payer: HFN Commercial |
$20,515.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$17,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$20,515.08
|
| Rate for Payer: Quartz Beloit One Network |
$10,926.51
|
| Rate for Payer: Quartz Commercial |
$14,494.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$12,264.45
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$16,516.87
|
|
|
RLHC Coronaries w/wo LV
|
Facility
|
IP
|
$22,299.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
3052500
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,926.51 |
| Max. Negotiated Rate |
$20,515.08 |
| Rate for Payer: Aetna Commercial |
$20,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19,177.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,818.47
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cigna Commercial |
$20,515.08
|
| Rate for Payer: Health EOS Commercial |
$19,846.11
|
| Rate for Payer: HFN Commercial |
$20,515.08
|
| Rate for Payer: Multiplan Commercial |
$17,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$13,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$20,515.08
|
| Rate for Payer: Quartz Beloit One Network |
$10,926.51
|
| Rate for Payer: Quartz Commercial |
$13,379.40
|
| Rate for Payer: WEA Trust Commercial |
$12,264.45
|
| Rate for Payer: WPS Commercial |
$16,516.87
|
|
|
RLHC w/wo LV
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
3052493
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$19,031.12 |
| Rate for Payer: Aetna Commercial |
$18,617.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,789.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,963.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cigna Commercial |
$19,031.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$18,410.54
|
| Rate for Payer: HFN Commercial |
$19,031.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$16,548.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$19,031.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,136.14
|
| Rate for Payer: Quartz Commercial |
$13,445.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$11,377.30
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$15,322.12
|
|
|
RLHC w/wo LV
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
3052493
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,136.14 |
| Max. Negotiated Rate |
$19,031.12 |
| Rate for Payer: Aetna Commercial |
$18,617.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,789.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,963.58
|
| Rate for Payer: Cash Price |
$6,205.80
|
| Rate for Payer: Cigna Commercial |
$19,031.12
|
| Rate for Payer: Health EOS Commercial |
$18,410.54
|
| Rate for Payer: HFN Commercial |
$19,031.12
|
| Rate for Payer: Multiplan Commercial |
$16,548.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,411.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,031.12
|
| Rate for Payer: Quartz Beloit One Network |
$10,136.14
|
| Rate for Payer: Quartz Commercial |
$12,411.60
|
| Rate for Payer: WEA Trust Commercial |
$11,377.30
|
| Rate for Payer: WPS Commercial |
$15,322.12
|
|
|
Rmvl Foreign Body Upper Arm/Elbow Sub 24200
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
4598815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.36 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Aetna Commercial |
$489.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.00
|
| Rate for Payer: Health EOS Commercial |
$468.65
|
| Rate for Payer: HFN Commercial |
$489.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$470.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.94
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Preferred Network Access Commercial |
$489.25
|
| Rate for Payer: Quartz Beloit One Network |
$226.60
|
| Rate for Payer: Quartz Commercial |
$293.55
|
| Rate for Payer: The Alliance Commercial |
$257.50
|
| Rate for Payer: United Healthcare Medicaid |
$64.36
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR 49623
|
Professional
|
Both
|
$2,054.00
|
|
|
Service Code
|
CPT 49623
|
| Hospital Charge Code |
6179924
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.41 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cash Price |
$616.20
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.40
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare Medicaid |
$139.41
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.40
|
|
|
RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR, EXT 4962322
|
Professional
|
Both
|
$2,465.00
|
|
|
Service Code
|
CPT 49623 22
|
| Hospital Charge Code |
6196919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.41 |
| Max. Negotiated Rate |
$2,341.75 |
| Rate for Payer: Aetna Commercial |
$2,341.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,119.90
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cigna Commercial |
$2,341.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,479.00
|
| Rate for Payer: Health EOS Commercial |
$2,243.15
|
| Rate for Payer: HFN Commercial |
$2,341.75
|
| Rate for Payer: Multiplan Commercial |
$1,972.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,341.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.60
|
| Rate for Payer: Quartz Commercial |
$1,405.05
|
| Rate for Payer: The Alliance Commercial |
$1,232.50
|
| Rate for Payer: United Healthcare Medicaid |
$139.41
|
| Rate for Payer: WEA Trust Commercial |
$1,355.75
|
| Rate for Payer: WPS Commercial |
$1,825.83
|
|
|
Rmvl Spinal Nstim Eltrd Prq Array Incl Fluor 63661
|
Professional
|
Both
|
$2,222.00
|
|
|
Service Code
|
CPT 63661
|
| Hospital Charge Code |
5426706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$453.93 |
| Max. Negotiated Rate |
$2,110.90 |
| Rate for Payer: Aetna Commercial |
$2,110.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,910.92
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cash Price |
$666.60
|
| Rate for Payer: Cigna Commercial |
$2,110.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$453.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,333.20
|
| Rate for Payer: Health EOS Commercial |
$2,022.02
|
| Rate for Payer: HFN Commercial |
$2,110.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,077.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,077.39
|
| Rate for Payer: Multiplan Commercial |
$1,777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,110.90
|
| Rate for Payer: Quartz Beloit One Network |
$977.68
|
| Rate for Payer: Quartz Commercial |
$1,266.54
|
| Rate for Payer: The Alliance Commercial |
$1,111.00
|
| Rate for Payer: United Healthcare Medicaid |
$453.93
|
| Rate for Payer: WEA Trust Commercial |
$1,222.10
|
| Rate for Payer: WPS Commercial |
$1,645.84
|
|
|
RNA Polymerase III Ab
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
RNA Polymerase III Ab
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
RNA Polymerase III Ab
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4586654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
RNP Antibody
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
RNP Antibody
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.54
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
RNP Antibody
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5360651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
RNP/SM to TheraTest
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$63.29 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.40
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: HFN Commercial |
$51.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
RNP/SM to TheraTest
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$71.72 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
