|
Special Dosimetry 7733126
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 77331 26
|
| Hospital Charge Code |
5258633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$287.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$45.93
|
| Rate for Payer: Anthem Medicare Advantage |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.93
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$287.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$275.40
|
| Rate for Payer: HFN Commercial |
$287.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$163.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$68.89
|
| Rate for Payer: Preferred Network Access Commercial |
$287.51
|
| Rate for Payer: Quartz Beloit One Network |
$133.16
|
| Rate for Payer: Quartz Commercial |
$172.50
|
| Rate for Payer: Quartz Medicare Advantage |
$45.93
|
| Rate for Payer: The Alliance Commercial |
$174.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.93
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$229.63
|
|
|
Special Ophthalmolgical Services: Biometry With IOL Calculation
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
1188927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$194.21 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$48.25
|
| Rate for Payer: Anthem Medicare Advantage |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.25
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.25
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$194.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.25
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$72.37
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$48.25
|
| Rate for Payer: The Alliance Commercial |
$120.61
|
| Rate for Payer: United Healthcare Medicaid |
$77.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.25
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$192.98
|
|
|
Special Ophthalmolgical Services: Corneal Topography With Interpretation
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
1188931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$147.93 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$36.98
|
| Rate for Payer: Anthem Medicare Advantage |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.98
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.98
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$55.47
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: Quartz Medicare Advantage |
$36.98
|
| Rate for Payer: The Alliance Commercial |
$92.46
|
| Rate for Payer: United Healthcare Medicaid |
$24.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.98
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$147.93
|
|
|
Special Ophthalmolgical Services: Fluorescein Angiography With Interpretation
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
1188929
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.79 |
| Max. Negotiated Rate |
$649.38 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$162.34
|
| Rate for Payer: Anthem Medicare Advantage |
$162.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.34
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$396.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.34
|
| Rate for Payer: Health EOS Commercial |
$379.51
|
| Rate for Payer: HFN Commercial |
$396.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.34
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$243.52
|
| Rate for Payer: Preferred Network Access Commercial |
$396.19
|
| Rate for Payer: Quartz Beloit One Network |
$183.50
|
| Rate for Payer: Quartz Commercial |
$237.71
|
| Rate for Payer: Quartz Medicare Advantage |
$162.34
|
| Rate for Payer: The Alliance Commercial |
$405.86
|
| Rate for Payer: United Healthcare Medicaid |
$112.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.34
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$649.38
|
|
|
Special Ophthalmolgical Services: Fundus Photography With Interpretation
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
1188928
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$148.22 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$37.06
|
| Rate for Payer: Anthem Medicare Advantage |
$37.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.06
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.06
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.06
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$55.58
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$37.06
|
| Rate for Payer: The Alliance Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.06
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$148.22
|
|
|
Special Ophthalmolgic Services: Extended Exam
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 92083
|
| Hospital Charge Code |
1188925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$255.30 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$63.82
|
| Rate for Payer: Anthem Medicare Advantage |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.82
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.82
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$95.74
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$63.82
|
| Rate for Payer: The Alliance Commercial |
$159.56
|
| Rate for Payer: United Healthcare Medicaid |
$31.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.82
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$255.30
|
|
|
Special Ophthalmological Services: Determination of Refractive State
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 92015
|
| Hospital Charge Code |
2634799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$69.49 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Anthem Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.45
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: United Healthcare Medicaid |
$10.37
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Special Ophthalmological Services: Gonioscopy
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 92020
|
| Hospital Charge Code |
1188890
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.61
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.61
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.61
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$24.91
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$16.61
|
| Rate for Payer: The Alliance Commercial |
$41.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.61
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$66.44
|
|
|
Special Ophthalmological Services: Sensorimotor Examination
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 92060
|
| Hospital Charge Code |
1188891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$64.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.42
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.42
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.42
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$96.63
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$64.42
|
| Rate for Payer: The Alliance Commercial |
$161.04
|
| Rate for Payer: United Healthcare Medicaid |
$49.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.42
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$257.67
|
|
|
Special Ophth Services Sensorimotor Exam 9206026
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 92060 26
|
| Hospital Charge Code |
4605871
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Medicare Advantage |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.69
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.69
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.69
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$55.04
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$36.69
|
| Rate for Payer: The Alliance Commercial |
$91.73
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.69
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$146.76
|
|
|
Special Physics Consultation
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$785.80 |
| Max. Negotiated Rate |
$1,475.39 |
| Rate for Payer: Aetna Commercial |
$1,443.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,379.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.95
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,475.39
|
| Rate for Payer: Health EOS Commercial |
$1,427.28
|
| Rate for Payer: HFN Commercial |
$1,475.39
|
| Rate for Payer: Multiplan Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,475.39
|
| Rate for Payer: Quartz Beloit One Network |
$785.80
|
| Rate for Payer: Quartz Commercial |
$962.21
|
| Rate for Payer: WEA Trust Commercial |
$882.02
|
| Rate for Payer: WPS Commercial |
$1,187.80
|
|
|
Special Physics Consultation
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$1,475.39 |
| Rate for Payer: Aetna Commercial |
$1,443.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,379.16
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,475.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$897.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$1,427.28
|
| Rate for Payer: HFN Commercial |
$1,475.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$1,282.94
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,475.39
|
| Rate for Payer: Quartz Beloit One Network |
$785.80
|
| Rate for Payer: Quartz Commercial |
$1,042.39
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$1,202.76
|
| Rate for Payer: WEA Trust Commercial |
$882.02
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$1,187.80
|
|
|
Special Stain For inclusion Bodies Or Parasites
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
1188853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Special stain including interpretation and report; group I for microorganisms (e.g., acid fast, methenamine silver)
|
Facility
|
OP
|
$219.36
|
|
|
Service Code
|
CPT 88312
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$219.36 |
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
|
|
Special stain including interpretation and report; group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry
|
Facility
|
OP
|
$560.06
|
|
|
Service Code
|
CPT 88313
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
|
|
Special Stains 1
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Commercial |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$214.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$205.37
|
| Rate for Payer: HFN Commercial |
$214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$214.40
|
| Rate for Payer: Quartz Beloit One Network |
$99.30
|
| Rate for Payer: Quartz Commercial |
$128.64
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Special Stains 1
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.38 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$169.26
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Special Stains 1
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Special Stains 2
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Special Stains 2
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Special Stains 2
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Commercial |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Special Treatment Procedure
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.48 |
| Max. Negotiated Rate |
$2,325.94 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Aetna Managed Medicare |
$581.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,269.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,815.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,724.57
|
| Rate for Payer: Anthem Medicare Advantage |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.48
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.48
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,163.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.48
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: NAPHCARE Commercial |
$872.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$952.48
|
| Rate for Payer: Quartz Medicare Advantage |
$581.48
|
| Rate for Payer: The Alliance Commercial |
$2,325.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.48
|
| Rate for Payer: United Healthcare PPO |
$1,099.02
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: Wellcare Medicare |
$581.48
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
Special Treatment Procedure
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$718.03 |
| Max. Negotiated Rate |
$1,348.13 |
| Rate for Payer: Aetna Commercial |
$1,318.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.64
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,348.13
|
| Rate for Payer: Health EOS Commercial |
$1,304.17
|
| Rate for Payer: HFN Commercial |
$1,348.13
|
| Rate for Payer: Multiplan Commercial |
$1,172.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,348.13
|
| Rate for Payer: Quartz Beloit One Network |
$718.03
|
| Rate for Payer: Quartz Commercial |
$879.22
|
| Rate for Payer: WEA Trust Commercial |
$805.95
|
| Rate for Payer: WPS Commercial |
$1,085.35
|
|
|
Special Treatment Procedure 77470
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
5516739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.06 |
| Max. Negotiated Rate |
$725.30 |
| Rate for Payer: Aetna Commercial |
$498.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.67
|
| Rate for Payer: Aetna Managed Medicare |
$145.06
|
| Rate for Payer: Anthem Medicare Advantage |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$145.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$145.06
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$498.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.06
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$498.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$145.06
|
| Rate for Payer: Multiplan Commercial |
$420.16
|
| Rate for Payer: NAPHCARE Commercial |
$217.59
|
| Rate for Payer: Preferred Network Access Commercial |
$498.94
|
| Rate for Payer: Quartz Beloit One Network |
$231.09
|
| Rate for Payer: Quartz Commercial |
$299.36
|
| Rate for Payer: Quartz Medicare Advantage |
$145.06
|
| Rate for Payer: The Alliance Commercial |
$551.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.06
|
| Rate for Payer: WEA Trust Commercial |
$288.86
|
| Rate for Payer: WPS Commercial |
$725.30
|
|
|
Specialty bed: Bariatric - Devices and Equipment
|
Facility
|
OP
|
$1,792.00
|
|
| Hospital Charge Code |
3031054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$1,714.59 |
| Rate for Payer: Aetna Commercial |
$1,677.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,602.76
|
| Rate for Payer: Aetna Managed Medicare |
$521.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,211.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.75
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,714.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.94
|
| Rate for Payer: Health EOS Commercial |
$1,658.68
|
| Rate for Payer: HFN Commercial |
$1,714.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,397.76
|
| Rate for Payer: Multiplan Commercial |
$1,490.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,118.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.59
|
| Rate for Payer: Quartz Beloit One Network |
$913.20
|
| Rate for Payer: Quartz Commercial |
$1,211.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,118.21
|
| Rate for Payer: The Alliance Commercial |
$931.84
|
| Rate for Payer: WEA Trust Commercial |
$1,025.02
|
| Rate for Payer: WPS Commercial |
$1,380.38
|
|
