|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$72,331.00
|
|
|
Service Code
|
MSDRG 258
|
| Min. Negotiated Rate |
$26,018.41 |
| Max. Negotiated Rate |
$72,331.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,018.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,855.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,579.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,403.38
|
| Rate for Payer: Anthem Medicare Advantage |
$26,018.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,018.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,018.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,018.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,961.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,018.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,817.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,018.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,018.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,018.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,018.41
|
| Rate for Payer: NAPHCARE Commercial |
$39,027.62
|
| Rate for Payer: Quartz Medicare Advantage |
$26,018.41
|
| Rate for Payer: The Alliance Commercial |
$72,331.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,018.41
|
| Rate for Payer: United Healthcare PPO |
$41,119.26
|
| Rate for Payer: Wellcare Medicare |
$26,018.41
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
|
IP
|
$49,946.00
|
|
|
Service Code
|
MSDRG 259
|
| Min. Negotiated Rate |
$17,966.11 |
| Max. Negotiated Rate |
$49,946.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,966.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,232.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,071.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,569.86
|
| Rate for Payer: Anthem Medicare Advantage |
$17,966.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,966.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,966.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,966.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,715.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,966.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,398.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,966.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,966.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,966.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,966.11
|
| Rate for Payer: NAPHCARE Commercial |
$26,949.16
|
| Rate for Payer: Quartz Medicare Advantage |
$17,966.11
|
| Rate for Payer: The Alliance Commercial |
$49,946.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,966.11
|
| Rate for Payer: United Healthcare PPO |
$28,336.85
|
| Rate for Payer: Wellcare Medicare |
$17,966.11
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
|
IP
|
$50,350.00
|
|
|
Service Code
|
MSDRG 261
|
| Min. Negotiated Rate |
$18,111.48 |
| Max. Negotiated Rate |
$50,350.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,111.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,111.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,111.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,111.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,111.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,111.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,695.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,111.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,111.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,111.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,111.48
|
| Rate for Payer: NAPHCARE Commercial |
$27,167.22
|
| Rate for Payer: Quartz Medicare Advantage |
$18,111.48
|
| Rate for Payer: The Alliance Commercial |
$50,350.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,111.48
|
| Rate for Payer: United Healthcare PPO |
$28,567.61
|
| Rate for Payer: Wellcare Medicare |
$18,111.48
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$88,458.00
|
|
|
Service Code
|
MSDRG 260
|
| Min. Negotiated Rate |
$31,819.51 |
| Max. Negotiated Rate |
$88,458.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,819.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,653.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,388.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,722.96
|
| Rate for Payer: Anthem Medicare Advantage |
$31,819.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,819.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,819.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,819.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,307.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,819.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,646.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,819.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,819.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,819.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,819.51
|
| Rate for Payer: NAPHCARE Commercial |
$47,729.26
|
| Rate for Payer: Quartz Medicare Advantage |
$31,819.51
|
| Rate for Payer: The Alliance Commercial |
$88,458.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,819.51
|
| Rate for Payer: United Healthcare PPO |
$50,328.05
|
| Rate for Payer: Wellcare Medicare |
$31,819.51
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$44,062.00
|
|
|
Service Code
|
MSDRG 262
|
| Min. Negotiated Rate |
$15,849.74 |
| Max. Negotiated Rate |
$44,062.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,849.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,617.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,533.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,208.70
|
| Rate for Payer: Anthem Medicare Advantage |
$15,849.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,849.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,849.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,849.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,983.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,849.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,083.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,849.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,849.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,849.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,849.74
|
| Rate for Payer: NAPHCARE Commercial |
$23,774.61
|
| Rate for Payer: Quartz Medicare Advantage |
$15,849.74
|
| Rate for Payer: The Alliance Commercial |
$44,062.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,849.74
|
| Rate for Payer: United Healthcare PPO |
$24,977.30
|
| Rate for Payer: Wellcare Medicare |
$15,849.74
|
|
|
CARDIAC SHUNT IMAGING 7842826
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
CPT 78428 26
|
| Hospital Charge Code |
3015314
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$463.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$463.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.80
|
| Rate for Payer: Health EOS Commercial |
$444.08
|
| Rate for Payer: HFN Commercial |
$463.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.72
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: Preferred Network Access Commercial |
$463.60
|
| Rate for Payer: Quartz Beloit One Network |
$214.72
|
| Rate for Payer: Quartz Commercial |
$278.16
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$169,548.00
|
|
|
Service Code
|
MSDRG 217
|
| Min. Negotiated Rate |
$60,988.50 |
| Max. Negotiated Rate |
$169,548.00 |
| Rate for Payer: Aetna Managed Medicare |
$60,988.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133,642.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102,435.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97,320.86
|
| Rate for Payer: Anthem Medicare Advantage |
$60,988.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60,988.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60,988.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60,988.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108,035.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60,988.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124,123.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60,988.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60,988.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60,988.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60,988.50
|
| Rate for Payer: NAPHCARE Commercial |
$91,482.75
|
| Rate for Payer: Quartz Medicare Advantage |
$60,988.50
|
| Rate for Payer: The Alliance Commercial |
$169,548.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60,988.50
|
| Rate for Payer: United Healthcare PPO |
$96,631.62
|
| Rate for Payer: Wellcare Medicare |
$60,988.50
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$258,345.00
|
|
|
Service Code
|
MSDRG 216
|
| Min. Negotiated Rate |
$92,929.91 |
| Max. Negotiated Rate |
$258,345.00 |
| Rate for Payer: Aetna Managed Medicare |
$92,929.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$203,715.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156,146.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148,349.38
|
| Rate for Payer: Anthem Medicare Advantage |
$92,929.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92,929.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92,929.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$92,929.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164,681.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$92,929.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189,253.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92,929.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92,929.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$92,929.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$92,929.91
|
| Rate for Payer: NAPHCARE Commercial |
$139,394.86
|
| Rate for Payer: Quartz Medicare Advantage |
$92,929.91
|
| Rate for Payer: The Alliance Commercial |
$258,345.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,929.91
|
| Rate for Payer: United Healthcare PPO |
$147,336.16
|
| Rate for Payer: Wellcare Medicare |
$92,929.91
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$151,773.00
|
|
|
Service Code
|
MSDRG 218
|
| Min. Negotiated Rate |
$54,594.48 |
| Max. Negotiated Rate |
$151,773.00 |
| Rate for Payer: Aetna Managed Medicare |
$54,594.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,661.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87,084.60
|
| Rate for Payer: Anthem Medicare Advantage |
$54,594.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54,594.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54,594.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54,594.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96,671.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54,594.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111,085.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54,594.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54,594.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54,594.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54,594.48
|
| Rate for Payer: NAPHCARE Commercial |
$81,891.72
|
| Rate for Payer: Quartz Medicare Advantage |
$54,594.48
|
| Rate for Payer: The Alliance Commercial |
$151,773.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54,594.48
|
| Rate for Payer: United Healthcare PPO |
$86,481.60
|
| Rate for Payer: Wellcare Medicare |
$54,594.48
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$139,753.00
|
|
|
Service Code
|
MSDRG 220
|
| Min. Negotiated Rate |
$50,270.92 |
| Max. Negotiated Rate |
$139,753.00 |
| Rate for Payer: Aetna Managed Medicare |
$50,270.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109,935.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84,264.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80,056.72
|
| Rate for Payer: Anthem Medicare Advantage |
$50,270.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50,270.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50,270.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$50,270.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88,870.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$50,270.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102,269.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50,270.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50,270.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$50,270.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$50,270.92
|
| Rate for Payer: NAPHCARE Commercial |
$75,406.38
|
| Rate for Payer: Quartz Medicare Advantage |
$50,270.92
|
| Rate for Payer: The Alliance Commercial |
$139,753.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50,270.92
|
| Rate for Payer: United Healthcare PPO |
$79,618.27
|
| Rate for Payer: Wellcare Medicare |
$50,270.92
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$205,330.00
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$73,859.74 |
| Max. Negotiated Rate |
$205,330.00 |
| Rate for Payer: Aetna Managed Medicare |
$73,859.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161,755.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123,984.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117,793.38
|
| Rate for Payer: Anthem Medicare Advantage |
$73,859.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73,859.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73,859.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73,859.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130,761.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73,859.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150,368.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73,859.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73,859.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73,859.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73,859.74
|
| Rate for Payer: NAPHCARE Commercial |
$110,789.61
|
| Rate for Payer: Quartz Medicare Advantage |
$73,859.74
|
| Rate for Payer: The Alliance Commercial |
$205,330.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73,859.74
|
| Rate for Payer: United Healthcare PPO |
$117,063.73
|
| Rate for Payer: Wellcare Medicare |
$73,859.74
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$123,908.00
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$44,571.20 |
| Max. Negotiated Rate |
$123,908.00 |
| Rate for Payer: Aetna Managed Medicare |
$44,571.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97,557.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74,776.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71,042.70
|
| Rate for Payer: Anthem Medicare Advantage |
$44,571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,571.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,571.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,571.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78,863.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,571.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90,647.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,571.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,571.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,571.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,571.20
|
| Rate for Payer: NAPHCARE Commercial |
$66,856.80
|
| Rate for Payer: Quartz Medicare Advantage |
$44,571.20
|
| Rate for Payer: The Alliance Commercial |
$123,908.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,571.20
|
| Rate for Payer: United Healthcare PPO |
$70,570.40
|
| Rate for Payer: Wellcare Medicare |
$44,571.20
|
|
|
Cardio IQ Adv Lipid / 92145
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.27
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Cardio IQ Adv Lipid / 92145
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Cardio IQ Adv Lipid / 92145
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.23
|
| Rate for Payer: Anthem Medicaid |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.39
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$13.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.39
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.39
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.84
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.39
|
| Rate for Payer: The Alliance Commercial |
$53.56
|
| Rate for Payer: United Healthcare Medicaid |
$13.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$13.39
|
| Rate for Payer: WMAP Medicaid |
$13.84
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Cardio IQ APOE Genotype
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.24 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna Commercial |
$542.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$542.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.60
|
| Rate for Payer: Health EOS Commercial |
$519.61
|
| Rate for Payer: HFN Commercial |
$542.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.61
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Preferred Network Access Commercial |
$542.45
|
| Rate for Payer: Quartz Beloit One Network |
$251.24
|
| Rate for Payer: Quartz Commercial |
$325.47
|
| Rate for Payer: The Alliance Commercial |
$285.50
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Cardio IQ APOE Genotype
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Aetna Commercial |
$513.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Aetna Managed Medicare |
$137.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.42
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.00
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$137.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.53
|
| Rate for Payer: Dean Health Medicaid |
$137.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$137.00
|
| Rate for Payer: Health EOS Commercial |
$508.19
|
| Rate for Payer: HFN Commercial |
$525.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.00
|
| Rate for Payer: Managed Health Services Medicaid |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$137.00
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: NAPHCARE Commercial |
$205.50
|
| Rate for Payer: Preferred Network Access Commercial |
$525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$137.00
|
| Rate for Payer: Quartz Beloit One Network |
$279.79
|
| Rate for Payer: Quartz Commercial |
$371.15
|
| Rate for Payer: Quartz Medicare Advantage |
$137.00
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: United Healthcare Medicaid |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare PPO |
$428.25
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: Wellcare Medicare |
$137.00
|
| Rate for Payer: WMAP Medicaid |
$137.00
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Cardio IQ APOE Genotype
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$279.79 |
| Max. Negotiated Rate |
$525.32 |
| Rate for Payer: Aetna Commercial |
$513.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.63
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$525.32
|
| Rate for Payer: Health EOS Commercial |
$508.19
|
| Rate for Payer: HFN Commercial |
$525.32
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: NAPHCARE Commercial |
$342.60
|
| Rate for Payer: Preferred Network Access Commercial |
$525.32
|
| Rate for Payer: Quartz Beloit One Network |
$279.79
|
| Rate for Payer: Quartz Commercial |
$342.60
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Cardiolipin Antibody IgA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$101.80
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$465.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
Cardiolipin Antibody IgA
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$396.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$396.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.20
|
| Rate for Payer: Health EOS Commercial |
$379.47
|
| Rate for Payer: HFN Commercial |
$396.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.15
|
| Rate for Payer: Quartz Beloit One Network |
$183.48
|
| Rate for Payer: Quartz Commercial |
$237.69
|
| Rate for Payer: The Alliance Commercial |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.35
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$101.80
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$312.75
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Cardiolipin Antibody IgG
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
