|
Stone Analysis
|
Facility
OP
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| Rate for Payer: Aetna Managed Medicare |
$11.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.22
|
| Rate for Payer: Anthem Medicaid |
$11.97
|
| Rate for Payer: Anthem Medicare Advantage |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.58
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.97
|
| Rate for Payer: Dean Health Medicaid |
$11.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.58
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.58
|
| Rate for Payer: Managed Health Services Medicaid |
$12.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.58
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.37
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.97
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$144.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11.58
|
| Rate for Payer: The Alliance Commercial |
$888.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.58
|
| Rate for Payer: United Healthcare PPO |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
| Rate for Payer: WMAP Medicaid |
$11.97
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
Stone Analysis
|
Facility
IP
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$204.24 |
| Rate for Payer: Aetna Commercial |
$199.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.66
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$204.24
|
| Rate for Payer: Health EOS Commercial |
$197.58
|
| Rate for Payer: HFN Commercial |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: NAPHCARE Commercial |
$133.20
|
| Rate for Payer: Preferred Network Access Commercial |
$204.24
|
| Rate for Payer: Quartz Beloit One Network |
$108.78
|
| Rate for Payer: Quartz Commercial |
$133.20
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$164.44
|
|
|
Stone Analysis
|
Professional
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$210.90 |
| Rate for Payer: Aetna Commercial |
$210.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.92
|
| Rate for Payer: Aetna Managed Medicare |
$11.58
|
| Rate for Payer: Anthem Medicare Advantage |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.58
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$210.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.58
|
| Rate for Payer: Health EOS Commercial |
$202.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.58
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Preferred Network Access Commercial |
$210.90
|
| Rate for Payer: Quartz Beloit One Network |
$97.68
|
| Rate for Payer: Quartz Commercial |
$126.54
|
| Rate for Payer: Quartz Medicare Advantage |
$11.58
|
| Rate for Payer: The Alliance Commercial |
$45.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.58
|
| Rate for Payer: WEA Trust Commercial |
$122.10
|
| Rate for Payer: WPS Commercial |
$50.95
|
|
|
Stone Analysis Charge
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
4063449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.94 |
| Max. Negotiated Rate |
$189.52 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.18
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$189.52
|
| Rate for Payer: Health EOS Commercial |
$183.34
|
| Rate for Payer: HFN Commercial |
$189.52
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: NAPHCARE Commercial |
$123.60
|
| Rate for Payer: Preferred Network Access Commercial |
$189.52
|
| Rate for Payer: Quartz Beloit One Network |
$100.94
|
| Rate for Payer: Quartz Commercial |
$123.60
|
| Rate for Payer: WEA Trust Commercial |
$113.30
|
| Rate for Payer: WPS Commercial |
$152.58
|
|
|
Stone Analysis Charge
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
4063449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.22
|
| Rate for Payer: Anthem Medicaid |
$11.97
|
| Rate for Payer: Anthem Medicare Advantage |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.58
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$189.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.97
|
| Rate for Payer: Dean Health Medicaid |
$11.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.58
|
| Rate for Payer: Health EOS Commercial |
$183.34
|
| Rate for Payer: HFN Commercial |
$189.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.58
|
| Rate for Payer: Managed Health Services Medicaid |
$12.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.58
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.37
|
| Rate for Payer: Preferred Network Access Commercial |
$189.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.97
|
| Rate for Payer: Quartz Beloit One Network |
$100.94
|
| Rate for Payer: Quartz Commercial |
$133.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.58
|
| Rate for Payer: The Alliance Commercial |
$824.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.58
|
| Rate for Payer: United Healthcare PPO |
$154.50
|
| Rate for Payer: WEA Trust Commercial |
$113.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
| Rate for Payer: WMAP Medicaid |
$11.97
|
| Rate for Payer: WPS Commercial |
$152.58
|
|
|
STONE CATCHER WITH TUBING LITHOCLAST M0068407501
|
Facility
OP
|
$1,179.00
|
|
| Hospital Charge Code |
5415202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.12 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| Rate for Payer: Aetna Managed Medicare |
$330.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$766.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.77
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$884.25
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$766.35
|
| Rate for Payer: Quartz Medicare Advantage |
$707.40
|
| Rate for Payer: The Alliance Commercial |
$4,716.00
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
STONE CATCHER WITH TUBING LITHOCLAST M0068407501
|
Facility
IP
|
$1,179.00
|
|
| Hospital Charge Code |
5415202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.71 |
| Max. Negotiated Rate |
$1,084.68 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$707.40
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
STONE MANIPULATION
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
STONE MANIPULATION
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Stone Risk Diagnostic Profile
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$23.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$26.53
|
|
|
Stone Risk Diagnostic Profile
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Stone Risk Diagnostic Profile
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Stone Track Diagnostic Monitoring Test
|
Professional
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$23.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$26.53
|
|
|
Stone Track Diagnostic Monitoring Test
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$89.25
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Stone Track Diagnostic Monitoring Test
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Stool Culture to Quest
|
Facility
OP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5472907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Stool Culture to Quest
|
Professional
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5472907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
Stool Culture to Quest
|
Facility
IP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5472907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Stool for Occult Blood POC 82272
|
Professional
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
4464944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$4.23
|
| Rate for Payer: Anthem Medicare Advantage |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.23
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.23
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: Quartz Medicare Advantage |
$4.23
|
| Rate for Payer: The Alliance Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$18.61
|
|
|
Stool for Occult Blood POC 82272
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
4464944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$4.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.02
|
| Rate for Payer: Anthem Medicaid |
$4.26
|
| Rate for Payer: Anthem Medicare Advantage |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.23
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.23
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.23
|
| Rate for Payer: Managed Health Services Medicaid |
$4.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.34
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.26
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.23
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$4.23
|
| Rate for Payer: WMAP Medicaid |
$4.26
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Stool for Occult Blood POC 82272
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
4464944
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Stool Leukocytes
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
979858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Stool Leukocytes
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
979858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$18.79
|
|
|
Stool Leukocytes
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
979858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$400.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
STOPCOCK 3 WAY H3FLC
|
Facility
OP
|
$62.00
|
|
| Hospital Charge Code |
6207025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.70
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
