|
Cardiolipin Antibody IgG
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$178.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
| Rate for Payer: Health EOS Commercial |
$171.08
|
| Rate for Payer: HFN Commercial |
$178.60
|
| 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 |
$150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.60
|
| Rate for Payer: Quartz Beloit One Network |
$82.72
|
| Rate for Payer: Quartz Commercial |
$107.16
|
| Rate for Payer: The Alliance Commercial |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Cardiolipin Antibody IgG
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| 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 |
$99.64
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| 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 |
$105.20
|
| 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 |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| 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 |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| 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 |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Cardiolipin Antibody IgG & IgM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Cardiolipin Antibody IgG & IgM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$266.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.00
|
| Rate for Payer: Health EOS Commercial |
$254.80
|
| Rate for Payer: HFN Commercial |
$266.00
|
| 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 |
$224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.00
|
| Rate for Payer: Quartz Beloit One Network |
$123.20
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Cardiolipin Antibody IgG & IgM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| 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 |
$148.40
|
| 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 |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| 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 |
$156.69
|
| 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 |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| 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 |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$182.00
|
| 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 |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Cardiolipin Antibody IgM
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
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
|
|
|
Cardiolipin Antibody IgM
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| 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 |
$99.64
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| 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 |
$105.20
|
| 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 |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| 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 |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| 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 |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Cardiolipin Antibody IgM
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$178.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
| Rate for Payer: Health EOS Commercial |
$171.08
|
| Rate for Payer: HFN Commercial |
$178.60
|
| 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 |
$150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.60
|
| Rate for Payer: Quartz Beloit One Network |
$82.72
|
| Rate for Payer: Quartz Commercial |
$107.16
|
| Rate for Payer: The Alliance Commercial |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
CARDIOVASCULAR STRESS TEST 93015
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
CPT 93015
|
| Hospital Charge Code |
3015355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.90 |
| Max. Negotiated Rate |
$457.90 |
| Rate for Payer: Aetna Commercial |
$457.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.52
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$457.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.20
|
| Rate for Payer: Health EOS Commercial |
$438.62
|
| Rate for Payer: HFN Commercial |
$457.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.39
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Preferred Network Access Commercial |
$457.90
|
| Rate for Payer: Quartz Beloit One Network |
$212.08
|
| Rate for Payer: Quartz Commercial |
$274.74
|
| Rate for Payer: The Alliance Commercial |
$241.00
|
| Rate for Payer: United Healthcare Medicaid |
$91.90
|
| Rate for Payer: WEA Trust Commercial |
$265.10
|
| Rate for Payer: WPS Commercial |
$357.02
|
|
|
Cardioversion
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3114196
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$577.22 |
| Max. Negotiated Rate |
$1,083.76 |
| Rate for Payer: Aetna Commercial |
$1,060.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.34
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,083.76
|
| Rate for Payer: Health EOS Commercial |
$1,048.42
|
| Rate for Payer: HFN Commercial |
$1,083.76
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: NAPHCARE Commercial |
$706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.76
|
| Rate for Payer: Quartz Beloit One Network |
$577.22
|
| Rate for Payer: Quartz Commercial |
$706.80
|
| Rate for Payer: WEA Trust Commercial |
$647.90
|
| Rate for Payer: WPS Commercial |
$872.54
|
|
|
Cardioversion
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3114196
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$565.44 |
| Max. Negotiated Rate |
$2,573.12 |
| Rate for Payer: Aetna Commercial |
$1,060.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.08
|
| Rate for Payer: Aetna Managed Medicare |
$643.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.44
|
| Rate for Payer: Anthem Medicare Advantage |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.28
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,083.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$643.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$643.28
|
| Rate for Payer: Health EOS Commercial |
$1,048.42
|
| Rate for Payer: HFN Commercial |
$1,083.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,393.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$643.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$643.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$643.28
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.76
|
| Rate for Payer: Quartz Beloit One Network |
$577.22
|
| Rate for Payer: Quartz Commercial |
$765.70
|
| Rate for Payer: Quartz Medicare Advantage |
$643.28
|
| Rate for Payer: The Alliance Commercial |
$2,573.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.28
|
| Rate for Payer: WEA Trust Commercial |
$647.90
|
| Rate for Payer: Wellcare Medicare |
$643.28
|
| Rate for Payer: WPS Commercial |
$872.54
|
|
|
Cardioversion Electric,EXT 92960
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3227480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$576.65 |
| Rate for Payer: Aetna Commercial |
$576.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$576.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.20
|
| Rate for Payer: Health EOS Commercial |
$552.37
|
| Rate for Payer: HFN Commercial |
$576.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$368.99
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$576.65
|
| Rate for Payer: Quartz Beloit One Network |
$267.08
|
| Rate for Payer: Quartz Commercial |
$345.99
|
| Rate for Payer: The Alliance Commercial |
$303.50
|
| Rate for Payer: United Healthcare Medicaid |
$239.96
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Cardioversion Electric,EXT 9296026
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
CPT 92960 26
|
| Hospital Charge Code |
4634616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.08 |
| Max. Negotiated Rate |
$576.65 |
| Rate for Payer: Aetna Commercial |
$576.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$576.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.20
|
| Rate for Payer: Health EOS Commercial |
$552.37
|
| Rate for Payer: HFN Commercial |
$576.65
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$576.65
|
| Rate for Payer: Quartz Beloit One Network |
$267.08
|
| Rate for Payer: Quartz Commercial |
$345.99
|
| Rate for Payer: The Alliance Commercial |
$303.50
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Cardioversion Performed By
|
Facility
|
IP
|
$6,028.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
2844880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,953.72 |
| Max. Negotiated Rate |
$5,545.76 |
| Rate for Payer: Aetna Commercial |
$5,425.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,184.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.84
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna Commercial |
$5,545.76
|
| Rate for Payer: Health EOS Commercial |
$5,364.92
|
| Rate for Payer: HFN Commercial |
$5,545.76
|
| Rate for Payer: Multiplan Commercial |
$4,822.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,616.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.72
|
| Rate for Payer: Quartz Commercial |
$3,616.80
|
| Rate for Payer: WEA Trust Commercial |
$3,315.40
|
| Rate for Payer: WPS Commercial |
$4,464.94
|
|
|
Cardioversion Performed By
|
Facility
|
OP
|
$6,028.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
2844880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,545.76 |
| Rate for Payer: Aetna Commercial |
$5,425.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,184.08
|
| Rate for Payer: Aetna Managed Medicare |
$643.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,918.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,014.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,893.44
|
| Rate for Payer: Anthem Medicare Advantage |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.28
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna Commercial |
$5,545.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$643.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,373.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$643.28
|
| Rate for Payer: Health EOS Commercial |
$5,364.92
|
| Rate for Payer: HFN Commercial |
$5,545.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,393.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$643.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$643.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$643.28
|
| Rate for Payer: Multiplan Commercial |
$4,822.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,545.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.72
|
| Rate for Payer: Quartz Commercial |
$3,918.20
|
| Rate for Payer: Quartz Medicare Advantage |
$643.28
|
| Rate for Payer: The Alliance Commercial |
$2,573.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,315.40
|
| Rate for Payer: Wellcare Medicare |
$643.28
|
| Rate for Payer: WPS Commercial |
$4,464.94
|
|
|
CARE OF MISCARRIAGE 59820
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
3015170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$1,387.95 |
| Rate for Payer: Aetna Commercial |
$1,387.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,387.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$876.60
|
| Rate for Payer: Health EOS Commercial |
$1,329.51
|
| Rate for Payer: HFN Commercial |
$1,387.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,232.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,232.46
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.95
|
| Rate for Payer: Quartz Beloit One Network |
$642.84
|
| Rate for Payer: Quartz Commercial |
$832.77
|
| Rate for Payer: The Alliance Commercial |
$730.50
|
| Rate for Payer: United Healthcare Medicaid |
$325.08
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
Carnitine Free and Total
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
977895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.00
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: HFN Commercial |
$403.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: The Alliance Commercial |
$212.50
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Carnitine Free and Total
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
977895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.83
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$276.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$67.48
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$318.75
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Carnitine Free and Total
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
977895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Carnitine, Urine
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
5280663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
Carnitine, Urine
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
5280663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: HFN Commercial |
$461.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
Carnitine, Urine
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
5280663
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.97
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$67.48
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$364.50
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
Carotene Level
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
977896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Aetna Commercial |
$476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$476.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.20
|
| Rate for Payer: Health EOS Commercial |
$456.82
|
| Rate for Payer: HFN Commercial |
$476.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.55
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Preferred Network Access Commercial |
$476.90
|
| Rate for Payer: Quartz Beloit One Network |
$220.88
|
| Rate for Payer: Quartz Commercial |
$286.14
|
| Rate for Payer: The Alliance Commercial |
$251.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
Carotene Level
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
977896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
Carotene Level
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
977896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$9.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.31
|
| Rate for Payer: Anthem Medicaid |
$9.53
|
| Rate for Payer: Anthem Medicare Advantage |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.22
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.92
|
| Rate for Payer: Dean Health Medicaid |
$9.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.22
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.22
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.83
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.53
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.22
|
| Rate for Payer: The Alliance Commercial |
$36.88
|
| Rate for Payer: United Healthcare Medicaid |
$9.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.22
|
| Rate for Payer: United Healthcare PPO |
$376.50
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: Wellcare Medicare |
$9.22
|
| Rate for Payer: WMAP Medicaid |
$9.53
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
