|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$157,843.92
|
|
|
Service Code
|
MSDRG 218
|
| Min. Negotiated Rate |
$50,861.72 |
| Max. Negotiated Rate |
$157,843.92 |
| Rate for Payer: Aetna Managed Medicare |
$50,861.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143,467.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109,966.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104,475.73
|
| Rate for Payer: Anthem Medicare Advantage |
$50,861.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50,861.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50,861.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$50,861.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115,977.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$50,861.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115,529.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50,861.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50,861.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$50,861.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$50,861.72
|
| Rate for Payer: NAPHCARE Commercial |
$76,292.58
|
| Rate for Payer: Quartz Medicare Advantage |
$50,861.72
|
| Rate for Payer: The Alliance Commercial |
$157,843.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50,861.72
|
| Rate for Payer: United Healthcare PPO |
$89,940.86
|
| Rate for Payer: Wellcare Medicare |
$50,861.72
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$145,343.12
|
|
|
Service Code
|
MSDRG 220
|
| Min. Negotiated Rate |
$41,346.42 |
| Max. Negotiated Rate |
$145,343.12 |
| Rate for Payer: Aetna Managed Medicare |
$41,346.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116,357.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89,187.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84,733.50
|
| Rate for Payer: Anthem Medicare Advantage |
$41,346.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41,346.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41,346.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41,346.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94,061.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41,346.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106,360.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41,346.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41,346.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41,346.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41,346.42
|
| Rate for Payer: NAPHCARE Commercial |
$62,019.63
|
| Rate for Payer: Quartz Medicare Advantage |
$41,346.42
|
| Rate for Payer: The Alliance Commercial |
$145,343.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,346.42
|
| Rate for Payer: United Healthcare PPO |
$82,803.00
|
| Rate for Payer: Wellcare Medicare |
$41,346.42
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$213,543.20
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$59,308.71 |
| Max. Negotiated Rate |
$213,543.20 |
| Rate for Payer: Aetna Managed Medicare |
$59,308.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167,534.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128,413.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122,001.43
|
| Rate for Payer: Anthem Medicare Advantage |
$59,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59,308.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59,308.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59,308.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135,432.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59,308.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156,383.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59,308.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59,308.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59,308.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59,308.71
|
| Rate for Payer: NAPHCARE Commercial |
$88,963.07
|
| Rate for Payer: Quartz Medicare Advantage |
$59,308.71
|
| Rate for Payer: The Alliance Commercial |
$213,543.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59,308.71
|
| Rate for Payer: United Healthcare PPO |
$121,746.28
|
| Rate for Payer: Wellcare Medicare |
$59,308.71
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$128,864.32
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$39,105.61 |
| Max. Negotiated Rate |
$128,864.32 |
| Rate for Payer: Aetna Managed Medicare |
$39,105.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109,973.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84,293.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80,084.34
|
| Rate for Payer: Anthem Medicare Advantage |
$39,105.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39,105.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39,105.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39,105.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88,900.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39,105.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94,273.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39,105.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39,105.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39,105.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39,105.61
|
| Rate for Payer: NAPHCARE Commercial |
$58,658.42
|
| Rate for Payer: Quartz Medicare Advantage |
$39,105.61
|
| Rate for Payer: The Alliance Commercial |
$128,864.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39,105.61
|
| Rate for Payer: United Healthcare PPO |
$73,393.22
|
| Rate for Payer: Wellcare Medicare |
$39,105.61
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$36,739.22
|
|
|
Service Code
|
APR-DRG 1621
|
| Min. Negotiated Rate |
$32,634.07 |
| Max. Negotiated Rate |
$36,739.22 |
| Rate for Payer: Anthem Medicaid |
$35,179.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35,179.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35,179.83
|
| Rate for Payer: Dean Health Medicaid |
$35,179.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,634.07
|
| Rate for Payer: Managed Health Services Medicaid |
$36,739.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,179.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35,179.83
|
| Rate for Payer: United Healthcare Medicaid |
$35,179.83
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$44,104.60
|
|
|
Service Code
|
APR-DRG 1622
|
| Min. Negotiated Rate |
$39,176.46 |
| Max. Negotiated Rate |
$44,104.60 |
| Rate for Payer: Anthem Medicaid |
$42,232.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$42,232.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42,232.58
|
| Rate for Payer: Dean Health Medicaid |
$42,232.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39,176.46
|
| Rate for Payer: Managed Health Services Medicaid |
$44,104.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,232.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42,232.58
|
| Rate for Payer: United Healthcare Medicaid |
$42,232.58
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$79,791.62
|
|
|
Service Code
|
APR-DRG 1624
|
| Min. Negotiated Rate |
$70,875.90 |
| Max. Negotiated Rate |
$79,791.62 |
| Rate for Payer: Anthem Medicaid |
$76,404.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$76,404.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76,404.87
|
| Rate for Payer: Dean Health Medicaid |
$76,404.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70,875.90
|
| Rate for Payer: Managed Health Services Medicaid |
$79,791.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$76,404.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$76,404.87
|
| Rate for Payer: United Healthcare Medicaid |
$76,404.87
|
|
|
CARDIAC VALVE PROCEDURES WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$58,396.94
|
|
|
Service Code
|
APR-DRG 1623
|
| Min. Negotiated Rate |
$51,871.81 |
| Max. Negotiated Rate |
$58,396.94 |
| Rate for Payer: Anthem Medicaid |
$55,918.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$55,918.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55,918.29
|
| Rate for Payer: Dean Health Medicaid |
$55,918.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$51,871.81
|
| Rate for Payer: Managed Health Services Medicaid |
$58,396.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$55,918.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$55,918.29
|
| Rate for Payer: United Healthcare Medicaid |
$55,918.29
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$50,242.42
|
|
|
Service Code
|
APR-DRG 1633
|
| Min. Negotiated Rate |
$44,628.45 |
| Max. Negotiated Rate |
$50,242.42 |
| Rate for Payer: Anthem Medicaid |
$48,109.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$48,109.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48,109.88
|
| Rate for Payer: Dean Health Medicaid |
$48,109.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44,628.45
|
| Rate for Payer: Managed Health Services Medicaid |
$50,242.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$48,109.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48,109.88
|
| Rate for Payer: United Healthcare Medicaid |
$48,109.88
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$37,089.95
|
|
|
Service Code
|
APR-DRG 1632
|
| Min. Negotiated Rate |
$32,945.61 |
| Max. Negotiated Rate |
$37,089.95 |
| Rate for Payer: Anthem Medicaid |
$35,515.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35,515.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35,515.67
|
| Rate for Payer: Dean Health Medicaid |
$35,515.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,945.61
|
| Rate for Payer: Managed Health Services Medicaid |
$37,089.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,515.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35,515.67
|
| Rate for Payer: United Healthcare Medicaid |
$35,515.67
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$31,039.82
|
|
|
Service Code
|
APR-DRG 1631
|
| Min. Negotiated Rate |
$27,571.50 |
| Max. Negotiated Rate |
$31,039.82 |
| Rate for Payer: Anthem Medicaid |
$29,722.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$29,722.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29,722.34
|
| Rate for Payer: Dean Health Medicaid |
$29,722.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27,571.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31,039.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,722.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29,722.34
|
| Rate for Payer: United Healthcare Medicaid |
$29,722.34
|
|
|
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$69,883.43
|
|
|
Service Code
|
APR-DRG 1634
|
| Min. Negotiated Rate |
$62,074.82 |
| Max. Negotiated Rate |
$69,883.43 |
| Rate for Payer: Anthem Medicaid |
$66,917.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$66,917.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66,917.24
|
| Rate for Payer: Dean Health Medicaid |
$66,917.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$62,074.82
|
| Rate for Payer: Managed Health Services Medicaid |
$69,883.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$66,917.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66,917.24
|
| Rate for Payer: United Healthcare Medicaid |
$66,917.24
|
|
|
CARDIOGRAM
|
Facility
|
OP
|
$30.14
|
|
|
Service Code
|
EAPG 00413
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: Anthem Medicaid |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.98
|
| Rate for Payer: Dean Health Medicaid |
$28.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.98
|
| Rate for Payer: Managed Health Services Medicaid |
$30.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.98
|
| Rate for Payer: United Healthcare Medicaid |
$28.98
|
|
|
Cardio IQ Adv Lipid / 92145
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Cardio IQ Adv Lipid / 92145
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$61.27
|
|
|
Cardio IQ Adv Lipid / 92145
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: United Healthcare PPO |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$13.93
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Cardio IQ APOE Genotype
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$290.98 |
| Max. Negotiated Rate |
$546.33 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$356.30
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
Cardio IQ APOE Genotype
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$626.91 |
| Rate for Payer: Aetna Commercial |
$564.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$564.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$296.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$540.39
|
| Rate for Payer: HFN Commercial |
$564.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$564.15
|
| Rate for Payer: Quartz Beloit One Network |
$261.29
|
| Rate for Payer: Quartz Commercial |
$338.49
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$562.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$626.91
|
|
|
Cardio IQ APOE Genotype
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
5454669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$569.92 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$142.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.52
|
| Rate for Payer: Anthem Medicare Advantage |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.48
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.48
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.48
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$213.72
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$386.00
|
| Rate for Payer: Quartz Medicare Advantage |
$142.48
|
| Rate for Payer: The Alliance Commercial |
$569.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.48
|
| Rate for Payer: United Healthcare PPO |
$445.38
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: Wellcare Medicare |
$142.48
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.94
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: United Healthcare PPO |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$260.21
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
Cardiolipin Antibody IgA
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.94
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$281.89
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$105.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: United Healthcare PPO |
$325.26
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
Cardiolipin Antibody IgA
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$412.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$412.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$394.65
|
| Rate for Payer: HFN Commercial |
$412.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$412.00
|
| Rate for Payer: Quartz Beloit One Network |
$190.82
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$104.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
Cardiolipin Antibody IgA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
977894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$612.56 |
| Rate for Payer: Aetna Commercial |
$612.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$26.47
|
| Rate for Payer: Anthem Medicare Advantage |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.47
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$612.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$586.77
|
| Rate for Payer: HFN Commercial |
$612.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.47
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$612.56
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: Quartz Medicare Advantage |
$26.47
|
| Rate for Payer: The Alliance Commercial |
$104.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.47
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
