|
BIPOLAR DISORDERS
|
Facility
|
IP
|
$15,870.64
|
|
|
Service Code
|
APR-DRG 7534
|
| Min. Negotiated Rate |
$14,097.29 |
| Max. Negotiated Rate |
$15,870.64 |
| Rate for Payer: Anthem Medicaid |
$15,197.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,197.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,197.01
|
| Rate for Payer: Dean Health Medicaid |
$15,197.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,097.29
|
| Rate for Payer: Managed Health Services Medicaid |
$15,870.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,197.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,197.01
|
| Rate for Payer: United Healthcare Medicaid |
$15,197.01
|
|
|
BI-POLAR HEAD SELF-CENTERING 28MM 42MM 1035-42-000
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6217174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.97 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,082.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,514.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,933.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,856.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,164.46
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,900.82
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,320.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,514.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,320.66
|
| Rate for Payer: The Alliance Commercial |
$1,933.88
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$2,864.75
|
|
|
BI-POLAR HEAD SELF-CENTERING 28MM 42MM 1035-42-000
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6217174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,895.20 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,320.66
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$2,864.75
|
|
|
BI-POLAR HEAD SELF-CENTERING 28MM 45MM 1035-45-000
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6217175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,895.20 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,320.66
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$2,864.75
|
|
|
BI-POLAR HEAD SELF-CENTERING 28MM 45MM 1035-45-000
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6217175
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.97 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,082.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,514.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,933.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,856.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,164.46
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,900.82
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,320.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,514.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,320.66
|
| Rate for Payer: The Alliance Commercial |
$1,933.88
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$2,864.75
|
|
|
BIRCH/MARSHALL MARCHETTI KRANZ (MMK) PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959844
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
BIRCH/MARSHALL MARCHETTI KRANZ (MMK) PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959844
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Birth Pack
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3040327
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Birth Pack
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3040327
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Bisphenol A and Creatinine, Random Urine
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3624168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.62
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: United Healthcare PPO |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: Wellcare Medicare |
$25.07
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Bisphenol A and Creatinine, Random Urine
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3624168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Bisphenol A and Creatinine, Random Urine
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
3624168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$142.27 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$142.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$136.28
|
| Rate for Payer: HFN Commercial |
$142.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$142.27
|
| Rate for Payer: Quartz Beloit One Network |
$65.89
|
| Rate for Payer: Quartz Commercial |
$85.36
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$99.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.33
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.69 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$239.62
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Bisphenol A, Free (Unconjugated), Serum
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3694183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
BK Virus DNA, Qualitative PCR
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
BK Virus DNA, Qualitative PCR
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$166.30
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
BK Virus DNA, Qualitative PCR
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5569255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$243.05 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$243.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$232.81
|
| Rate for Payer: HFN Commercial |
$243.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$243.05
|
| Rate for Payer: Quartz Beloit One Network |
$112.57
|
| Rate for Payer: Quartz Commercial |
$145.83
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
BK Virus DNA, Quantitative, PCR
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
BK Virus DNA, Quantitative, PCR
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$469.56
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
BK Virus DNA, Quantitative, PCR
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1037563
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$326.51
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$376.74
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$477.20 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$477.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$457.11
|
| Rate for Payer: HFN Commercial |
$477.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$477.20
|
| Rate for Payer: Quartz Beloit One Network |
$221.02
|
| Rate for Payer: Quartz Commercial |
$286.32
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
BK Virus DNA, Quantitative PCR, Urine
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
5343771
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.14 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$301.39
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
BLADDER CALCULUS REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959846
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
