|
zzCV Removal of IABP
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1478833
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$783.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.61
|
| Rate for Payer: Aetna Managed Medicare |
$243.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$565.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$435.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$417.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.35
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Cigna Commercial |
$800.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$774.73
|
| Rate for Payer: HFN Commercial |
$800.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$652.86
|
| Rate for Payer: Multiplan Commercial |
$696.38
|
| Rate for Payer: NAPHCARE Commercial |
$522.29
|
| Rate for Payer: Preferred Network Access Commercial |
$800.84
|
| Rate for Payer: Quartz Beloit One Network |
$426.54
|
| Rate for Payer: Quartz Commercial |
$565.81
|
| Rate for Payer: Quartz Medicare Advantage |
$522.29
|
| Rate for Payer: The Alliance Commercial |
$109.45
|
| Rate for Payer: WEA Trust Commercial |
$478.76
|
| Rate for Payer: WPS Commercial |
$644.74
|
|
|
zzCV Removal of IABP
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1478833
|
| Min. Negotiated Rate |
$426.54 |
| Max. Negotiated Rate |
$800.84 |
| Rate for Payer: Aetna Commercial |
$783.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.35
|
| Rate for Payer: Cash Price |
$251.10
|
| Rate for Payer: Cigna Commercial |
$800.84
|
| Rate for Payer: Health EOS Commercial |
$774.73
|
| Rate for Payer: HFN Commercial |
$800.84
|
| Rate for Payer: Multiplan Commercial |
$696.38
|
| Rate for Payer: Preferred Network Access Commercial |
$800.84
|
| Rate for Payer: Quartz Beloit One Network |
$426.54
|
| Rate for Payer: Quartz Commercial |
$522.29
|
| Rate for Payer: WEA Trust Commercial |
$478.76
|
| Rate for Payer: WPS Commercial |
$644.74
|
|
|
zzCV Renal Catheter Perc Placement Left
|
Facility
|
IP
|
$7,485.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
630567
|
| Min. Negotiated Rate |
$3,814.36 |
| Max. Negotiated Rate |
$7,161.65 |
| Rate for Payer: Aetna Commercial |
$7,005.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,694.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,125.73
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cigna Commercial |
$7,161.65
|
| Rate for Payer: Health EOS Commercial |
$6,928.12
|
| Rate for Payer: HFN Commercial |
$7,161.65
|
| Rate for Payer: Multiplan Commercial |
$6,227.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,161.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,814.36
|
| Rate for Payer: Quartz Commercial |
$4,670.64
|
| Rate for Payer: WEA Trust Commercial |
$4,281.42
|
| Rate for Payer: WPS Commercial |
$5,765.70
|
|
|
zzCV Renal Catheter Perc Placement Left
|
Facility
|
OP
|
$7,485.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
630567
|
| Min. Negotiated Rate |
$2,179.63 |
| Max. Negotiated Rate |
$7,161.65 |
| Rate for Payer: Aetna Commercial |
$7,005.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,694.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,179.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,059.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,892.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,736.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,125.73
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cigna Commercial |
$7,161.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,356.27
|
| Rate for Payer: Health EOS Commercial |
$6,928.12
|
| Rate for Payer: HFN Commercial |
$7,161.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,838.30
|
| Rate for Payer: Multiplan Commercial |
$6,227.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,670.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,161.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,814.36
|
| Rate for Payer: Quartz Commercial |
$5,059.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,670.64
|
| Rate for Payer: The Alliance Commercial |
$3,892.20
|
| Rate for Payer: WEA Trust Commercial |
$4,281.42
|
| Rate for Payer: WPS Commercial |
$5,765.70
|
|
|
zzCV Renal Catheter Perc Placement Right
|
Facility
|
OP
|
$7,485.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
630571
|
| Min. Negotiated Rate |
$2,179.63 |
| Max. Negotiated Rate |
$7,161.65 |
| Rate for Payer: Aetna Commercial |
$7,005.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,694.58
|
| Rate for Payer: Aetna Managed Medicare |
$2,179.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,059.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,892.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,736.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,125.73
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cigna Commercial |
$7,161.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,356.27
|
| Rate for Payer: Health EOS Commercial |
$6,928.12
|
| Rate for Payer: HFN Commercial |
$7,161.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,838.30
|
| Rate for Payer: Multiplan Commercial |
$6,227.52
|
| Rate for Payer: NAPHCARE Commercial |
$4,670.64
|
| Rate for Payer: Preferred Network Access Commercial |
$7,161.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,814.36
|
| Rate for Payer: Quartz Commercial |
$5,059.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4,670.64
|
| Rate for Payer: The Alliance Commercial |
$3,892.20
|
| Rate for Payer: WEA Trust Commercial |
$4,281.42
|
| Rate for Payer: WPS Commercial |
$5,765.70
|
|
|
zzCV Renal Catheter Perc Placement Right
|
Facility
|
IP
|
$7,485.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
630571
|
| Min. Negotiated Rate |
$3,814.36 |
| Max. Negotiated Rate |
$7,161.65 |
| Rate for Payer: Aetna Commercial |
$7,005.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,694.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,125.73
|
| Rate for Payer: Cash Price |
$2,245.50
|
| Rate for Payer: Cigna Commercial |
$7,161.65
|
| Rate for Payer: Health EOS Commercial |
$6,928.12
|
| Rate for Payer: HFN Commercial |
$7,161.65
|
| Rate for Payer: Multiplan Commercial |
$6,227.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,161.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,814.36
|
| Rate for Payer: Quartz Commercial |
$4,670.64
|
| Rate for Payer: WEA Trust Commercial |
$4,281.42
|
| Rate for Payer: WPS Commercial |
$5,765.70
|
|
|
zzCV Reposition of Pace/ICD Lead
|
Facility
|
OP
|
$6,251.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
1478807
|
| Min. Negotiated Rate |
$3,120.50 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$5,850.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,590.89
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,225.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,250.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,120.50
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,445.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,875.30
|
| Rate for Payer: Cash Price |
$1,875.30
|
| Rate for Payer: Cigna Commercial |
$5,980.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$5,785.93
|
| Rate for Payer: HFN Commercial |
$5,980.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$5,200.83
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.51
|
| Rate for Payer: Quartz Commercial |
$4,225.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$3,575.57
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$4,815.15
|
|
|
zzCV Reposition of Pace/ICD Lead
|
Facility
|
IP
|
$6,251.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
1478807
|
| Min. Negotiated Rate |
$3,185.51 |
| Max. Negotiated Rate |
$5,980.96 |
| Rate for Payer: Aetna Commercial |
$5,850.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,590.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,445.55
|
| Rate for Payer: Cash Price |
$1,875.30
|
| Rate for Payer: Cigna Commercial |
$5,980.96
|
| Rate for Payer: Health EOS Commercial |
$5,785.93
|
| Rate for Payer: HFN Commercial |
$5,980.96
|
| Rate for Payer: Multiplan Commercial |
$5,200.83
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.51
|
| Rate for Payer: Quartz Commercial |
$3,900.62
|
| Rate for Payer: WEA Trust Commercial |
$3,575.57
|
| Rate for Payer: WPS Commercial |
$4,815.15
|
|
|
zzCV Revision Pacemaker Pocket
|
Facility
|
OP
|
$5,959.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1478812
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$5,577.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,329.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,028.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,098.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,974.73
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,284.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cash Price |
$1,787.70
|
| Rate for Payer: Cash Price |
$1,787.70
|
| Rate for Payer: Cigna Commercial |
$5,701.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$5,515.65
|
| Rate for Payer: HFN Commercial |
$5,701.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$4,957.89
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,701.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,036.71
|
| Rate for Payer: Quartz Commercial |
$4,028.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: WEA Trust Commercial |
$3,408.55
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$4,590.22
|
|
|
zzCV Revision Pacemaker Pocket
|
Facility
|
IP
|
$5,959.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1478812
|
| Min. Negotiated Rate |
$3,036.71 |
| Max. Negotiated Rate |
$5,701.57 |
| Rate for Payer: Aetna Commercial |
$5,577.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,329.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,284.60
|
| Rate for Payer: Cash Price |
$1,787.70
|
| Rate for Payer: Cigna Commercial |
$5,701.57
|
| Rate for Payer: Health EOS Commercial |
$5,515.65
|
| Rate for Payer: HFN Commercial |
$5,701.57
|
| Rate for Payer: Multiplan Commercial |
$4,957.89
|
| Rate for Payer: Preferred Network Access Commercial |
$5,701.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,036.71
|
| Rate for Payer: Quartz Commercial |
$3,718.42
|
| Rate for Payer: WEA Trust Commercial |
$3,408.55
|
| Rate for Payer: WPS Commercial |
$4,590.22
|
|
|
zzCV Temporary Pacemaker
|
Facility
|
IP
|
$4,446.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1478802
|
| Min. Negotiated Rate |
$2,265.68 |
| Max. Negotiated Rate |
$4,253.93 |
| Rate for Payer: Aetna Commercial |
$4,161.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,976.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,450.64
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,253.93
|
| Rate for Payer: Health EOS Commercial |
$4,115.22
|
| Rate for Payer: HFN Commercial |
$4,253.93
|
| Rate for Payer: Multiplan Commercial |
$3,699.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,253.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.68
|
| Rate for Payer: Quartz Commercial |
$2,774.30
|
| Rate for Payer: WEA Trust Commercial |
$2,543.11
|
| Rate for Payer: WPS Commercial |
$3,424.75
|
|
|
zzCV Temporary Pacemaker
|
Facility
|
OP
|
$4,446.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1478802
|
| Min. Negotiated Rate |
$2,219.44 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$4,161.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,976.50
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,005.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,311.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,219.44
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,450.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,253.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$4,115.22
|
| Rate for Payer: HFN Commercial |
$4,253.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$3,699.07
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,253.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.68
|
| Rate for Payer: Quartz Commercial |
$3,005.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: WEA Trust Commercial |
$2,543.11
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$3,424.75
|
|
|
zzCV Venogram Cava Inferior
|
Facility
|
IP
|
$7,465.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
629672
|
| Min. Negotiated Rate |
$3,804.16 |
| Max. Negotiated Rate |
$7,142.51 |
| Rate for Payer: Aetna Commercial |
$6,987.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,676.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,114.71
|
| Rate for Payer: Cash Price |
$2,239.50
|
| Rate for Payer: Cigna Commercial |
$7,142.51
|
| Rate for Payer: Health EOS Commercial |
$6,909.60
|
| Rate for Payer: HFN Commercial |
$7,142.51
|
| Rate for Payer: Multiplan Commercial |
$6,210.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,142.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,804.16
|
| Rate for Payer: Quartz Commercial |
$4,658.16
|
| Rate for Payer: WEA Trust Commercial |
$4,269.98
|
| Rate for Payer: WPS Commercial |
$5,750.29
|
|
|
zzCV Venogram Cava Inferior
|
Facility
|
OP
|
$7,465.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
629672
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,987.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,676.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,046.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,881.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,726.53
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,114.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,239.50
|
| Rate for Payer: Cash Price |
$2,239.50
|
| Rate for Payer: Cigna Commercial |
$7,142.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,344.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$6,909.60
|
| Rate for Payer: HFN Commercial |
$7,142.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$6,210.88
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,142.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,804.16
|
| Rate for Payer: Quartz Commercial |
$5,046.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$4,269.98
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$5,750.29
|
|
|
zzCV Venogram Cava Superior
|
Facility
|
IP
|
$6,544.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
629674
|
| Min. Negotiated Rate |
$3,334.82 |
| Max. Negotiated Rate |
$6,261.30 |
| Rate for Payer: Aetna Commercial |
$6,125.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,852.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,607.05
|
| Rate for Payer: Cash Price |
$1,963.20
|
| Rate for Payer: Cigna Commercial |
$6,261.30
|
| Rate for Payer: Health EOS Commercial |
$6,057.13
|
| Rate for Payer: HFN Commercial |
$6,261.30
|
| Rate for Payer: Multiplan Commercial |
$5,444.61
|
| Rate for Payer: Preferred Network Access Commercial |
$6,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,334.82
|
| Rate for Payer: Quartz Commercial |
$4,083.46
|
| Rate for Payer: WEA Trust Commercial |
$3,743.17
|
| Rate for Payer: WPS Commercial |
$5,040.84
|
|
|
zzCV Venogram Cava Superior
|
Facility
|
OP
|
$6,544.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
629674
|
| Min. Negotiated Rate |
$1,656.63 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$6,125.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,852.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,423.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,402.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,266.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,607.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$1,963.20
|
| Rate for Payer: Cash Price |
$1,963.20
|
| Rate for Payer: Cigna Commercial |
$6,261.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,808.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$6,057.13
|
| Rate for Payer: HFN Commercial |
$6,261.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$5,444.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,261.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,334.82
|
| Rate for Payer: Quartz Commercial |
$4,423.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$3,743.17
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$5,040.84
|
|
|
zzEEG, AWAKE AND ASLEEP 9581926
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 95819 26
|
| Hospital Charge Code |
3015467
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$396.19 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$56.97
|
| Rate for Payer: Anthem Medicare Advantage |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.97
|
| 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 |
$42.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.97
|
| Rate for Payer: Health EOS Commercial |
$379.51
|
| Rate for Payer: HFN Commercial |
$396.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$205.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.97
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$85.46
|
| 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 |
$56.97
|
| Rate for Payer: The Alliance Commercial |
$142.43
|
| Rate for Payer: United Healthcare Medicaid |
$42.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$227.88
|
|
|
zzEEG, OVER 1 HOUR 9581326
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
CPT 95813 26
|
| Hospital Charge Code |
6121638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$455.47 |
| Rate for Payer: Aetna Commercial |
$455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$88.65
|
| Rate for Payer: Anthem Medicare Advantage |
$88.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.65
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$455.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.65
|
| Rate for Payer: Health EOS Commercial |
$436.29
|
| Rate for Payer: HFN Commercial |
$455.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.65
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$132.97
|
| Rate for Payer: Preferred Network Access Commercial |
$455.47
|
| Rate for Payer: Quartz Beloit One Network |
$210.95
|
| Rate for Payer: Quartz Commercial |
$273.28
|
| Rate for Payer: Quartz Medicare Advantage |
$88.65
|
| Rate for Payer: The Alliance Commercial |
$221.62
|
| Rate for Payer: United Healthcare Medicaid |
$87.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.65
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$354.60
|
|
|
zzESOPHAGEAL ABLATION (HALO PROCEDURE)
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
2960020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,281.64 |
| Max. Negotiated Rate |
$2,406.35 |
| Rate for Payer: Aetna Commercial |
$2,354.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.27
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cigna Commercial |
$2,406.35
|
| Rate for Payer: Health EOS Commercial |
$2,327.88
|
| Rate for Payer: HFN Commercial |
$2,406.35
|
| Rate for Payer: Multiplan Commercial |
$2,092.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.64
|
| Rate for Payer: Quartz Commercial |
$1,569.36
|
| Rate for Payer: WEA Trust Commercial |
$1,438.58
|
| Rate for Payer: WPS Commercial |
$1,937.30
|
|
|
zzESOPHAGEAL ABLATION (HALO PROCEDURE)
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
2960020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$661.47 |
| Max. Negotiated Rate |
$3,914.73 |
| Rate for Payer: Aetna Commercial |
$2,354.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.42
|
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cash Price |
$754.50
|
| Rate for Payer: Cigna Commercial |
$2,406.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Health EOS Commercial |
$2,327.88
|
| Rate for Payer: HFN Commercial |
$2,406.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: Multiplan Commercial |
$2,092.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.64
|
| Rate for Payer: Quartz Commercial |
$1,700.14
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$1,438.58
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
| Rate for Payer: WPS Commercial |
$1,937.30
|
|
|
zzFlu A/B
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
zzFlu A/B
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$68.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: United Healthcare PPO |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: Wellcare Medicare |
$17.21
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
zzFlu A/B
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
979861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$181.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$174.14
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$84.20
|
| Rate for Payer: Quartz Commercial |
$109.08
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$67.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$75.73
|
|
|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$192.19
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
zzHerpes Simplex Virus Type I & II IgM w/ Reflex (Obsolete)
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
977975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$208.21
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
