|
Revision of Upper Eyelid 1582350
|
Professional
|
Both
|
$4,990.00
|
|
|
Service Code
|
CPT 15823 50
|
| Hospital Charge Code |
4422813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$554.68 |
| Max. Negotiated Rate |
$4,740.50 |
| Rate for Payer: Aetna Commercial |
$4,740.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,291.40
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cigna Commercial |
$4,740.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$554.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,994.00
|
| Rate for Payer: Health EOS Commercial |
$4,540.90
|
| Rate for Payer: HFN Commercial |
$4,740.50
|
| Rate for Payer: Multiplan Commercial |
$3,992.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,740.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.60
|
| Rate for Payer: Quartz Commercial |
$2,844.30
|
| Rate for Payer: The Alliance Commercial |
$2,495.00
|
| Rate for Payer: United Healthcare Medicaid |
$554.68
|
| Rate for Payer: WEA Trust Commercial |
$2,744.50
|
| Rate for Payer: WPS Commercial |
$3,696.09
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$21,726.56
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
|
|
REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$13,452.32
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,363.08 |
| Max. Negotiated Rate |
$13,452.32 |
| Rate for Payer: Aetna Managed Medicare |
$3,363.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,363.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,363.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,363.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,363.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,363.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,510.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,363.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,363.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,363.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,363.08
|
| Rate for Payer: NAPHCARE Commercial |
$5,044.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.08
|
| Rate for Payer: The Alliance Commercial |
$13,452.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,363.08
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,363.08
|
|
|
REVJ URINARY-CUTANEOUS ANASTAMOSIS (revise urinary opening to skin) 50727
|
Professional
|
Both
|
$2,035.00
|
|
|
Service Code
|
CPT 50727
|
| Hospital Charge Code |
6173583
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$771.17 |
| Max. Negotiated Rate |
$1,933.25 |
| Rate for Payer: Aetna Commercial |
$1,933.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,750.10
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cigna Commercial |
$1,933.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$771.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.00
|
| Rate for Payer: Health EOS Commercial |
$1,851.85
|
| Rate for Payer: HFN Commercial |
$1,933.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,706.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,706.01
|
| Rate for Payer: Multiplan Commercial |
$1,628.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,933.25
|
| Rate for Payer: Quartz Beloit One Network |
$895.40
|
| Rate for Payer: Quartz Commercial |
$1,159.95
|
| Rate for Payer: The Alliance Commercial |
$1,017.50
|
| Rate for Payer: United Healthcare Medicaid |
$771.17
|
| Rate for Payer: WEA Trust Commercial |
$1,119.25
|
| Rate for Payer: WPS Commercial |
$1,507.32
|
|
|
REVSE CUT NDL 369MM 1/2 CIRCLE W/ LOOP AR-7280
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
5611604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
REVSE CUT NDL 369MM 1/2 CIRCLE W/ LOOP AR-7280
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
5611604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
RHC
|
Facility
|
OP
|
$12,260.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
3052491
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$11,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,543.60
|
| 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 |
$6,497.80
|
| 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 |
$3,678.00
|
| Rate for Payer: Cash Price |
$3,678.00
|
| Rate for Payer: Cash Price |
$3,678.00
|
| Rate for Payer: Cigna Commercial |
$11,279.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,860.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$10,911.40
|
| Rate for Payer: HFN Commercial |
$11,279.20
|
| 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 |
$9,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$11,279.20
|
| Rate for Payer: Quartz Beloit One Network |
$6,007.40
|
| Rate for Payer: Quartz Commercial |
$7,969.00
|
| 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 |
$6,743.00
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$9,080.98
|
|
|
RHC
|
Facility
|
IP
|
$12,260.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
3052491
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,007.40 |
| Max. Negotiated Rate |
$11,279.20 |
| Rate for Payer: Aetna Commercial |
$11,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,543.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,497.80
|
| Rate for Payer: Cash Price |
$3,678.00
|
| Rate for Payer: Cigna Commercial |
$11,279.20
|
| Rate for Payer: Health EOS Commercial |
$10,911.40
|
| Rate for Payer: HFN Commercial |
$11,279.20
|
| Rate for Payer: Multiplan Commercial |
$9,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,279.20
|
| Rate for Payer: Quartz Beloit One Network |
$6,007.40
|
| Rate for Payer: Quartz Commercial |
$7,356.00
|
| Rate for Payer: WEA Trust Commercial |
$6,743.00
|
| Rate for Payer: WPS Commercial |
$9,080.98
|
|
|
RHC, Coronaries
|
Facility
|
IP
|
$17,820.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
3052496
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,731.80 |
| Max. Negotiated Rate |
$16,394.40 |
| Rate for Payer: Aetna Commercial |
$16,038.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,325.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,444.60
|
| Rate for Payer: Cash Price |
$5,346.00
|
| Rate for Payer: Cigna Commercial |
$16,394.40
|
| Rate for Payer: Health EOS Commercial |
$15,859.80
|
| Rate for Payer: HFN Commercial |
$16,394.40
|
| Rate for Payer: Multiplan Commercial |
$14,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,692.00
|
| Rate for Payer: Preferred Network Access Commercial |
$16,394.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,731.80
|
| Rate for Payer: Quartz Commercial |
$10,692.00
|
| Rate for Payer: WEA Trust Commercial |
$9,801.00
|
| Rate for Payer: WPS Commercial |
$13,199.27
|
|
|
RHC, Coronaries
|
Facility
|
OP
|
$17,820.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
3052496
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$16,038.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,325.20
|
| 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 |
$9,444.60
|
| 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 |
$5,346.00
|
| Rate for Payer: Cash Price |
$5,346.00
|
| Rate for Payer: Cash Price |
$5,346.00
|
| Rate for Payer: Cigna Commercial |
$16,394.40
|
| 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 |
$15,859.80
|
| Rate for Payer: HFN Commercial |
$16,394.40
|
| 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 |
$14,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$16,394.40
|
| Rate for Payer: Quartz Beloit One Network |
$8,731.80
|
| Rate for Payer: Quartz Commercial |
$11,583.00
|
| 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 |
$9,801.00
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$13,199.27
|
|
|
RHC Coronaries/BPG
|
Facility
|
OP
|
$21,479.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
3052497
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$19,760.68 |
| Rate for Payer: Aetna Commercial |
$19,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,471.94
|
| 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 |
$11,383.87
|
| 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 |
$6,443.70
|
| Rate for Payer: Cash Price |
$6,443.70
|
| Rate for Payer: Cash Price |
$6,443.70
|
| Rate for Payer: Cigna Commercial |
$19,760.68
|
| 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 |
$19,116.31
|
| Rate for Payer: HFN Commercial |
$19,760.68
|
| 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 |
$17,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$19,760.68
|
| Rate for Payer: Quartz Beloit One Network |
$10,524.71
|
| Rate for Payer: Quartz Commercial |
$13,961.35
|
| 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 |
$11,813.45
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$15,909.50
|
|
|
RHC Coronaries/BPG
|
Facility
|
IP
|
$21,479.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
3052497
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,524.71 |
| Max. Negotiated Rate |
$19,760.68 |
| Rate for Payer: Aetna Commercial |
$19,331.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,471.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,383.87
|
| Rate for Payer: Cash Price |
$6,443.70
|
| Rate for Payer: Cigna Commercial |
$19,760.68
|
| Rate for Payer: Health EOS Commercial |
$19,116.31
|
| Rate for Payer: HFN Commercial |
$19,760.68
|
| Rate for Payer: Multiplan Commercial |
$17,183.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,887.40
|
| Rate for Payer: Preferred Network Access Commercial |
$19,760.68
|
| Rate for Payer: Quartz Beloit One Network |
$10,524.71
|
| Rate for Payer: Quartz Commercial |
$12,887.40
|
| Rate for Payer: WEA Trust Commercial |
$11,813.45
|
| Rate for Payer: WPS Commercial |
$15,909.50
|
|
|
Rh Discrepancy Analysis
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
5374635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
Rh Discrepancy Analysis
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
5374635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$160.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.09
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$343.20
|
| Rate for Payer: The Alliance Commercial |
$2,288.00
|
| Rate for Payer: United Healthcare PPO |
$429.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
Rh Discrepancy Analysis
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
5374635
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.68 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.20
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: The Alliance Commercial |
$286.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
Rheumatoid Factor 3 IgA
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$46.12 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgA
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgA
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgG
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgG
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgG
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2950363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$46.12 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Rheumatoid Factor 3 IgM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2950362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| 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 |
$20.14
|
| 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 |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| 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 |
$21.26
|
| 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 |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| 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 |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| 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 |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Rheumatoid Factor 3 IgM
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2950362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Rheumatoid Factor 3 IgM
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2950362
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| 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 |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Rheumatoid Factor IgA Antibody
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| 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 |
$80.56
|
| 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 |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| 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 |
$85.06
|
| 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 |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| 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 |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| 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 |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
