|
Cardiolipin Antibody IgG
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| 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 |
$103.63
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| 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 |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| 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 |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Cardiolipin Antibody IgG
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Cardiolipin Antibody IgG
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$185.74 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$185.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$177.92
|
| Rate for Payer: HFN Commercial |
$185.74
|
| 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 |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$185.74
|
| Rate for Payer: Quartz Beloit One Network |
$86.03
|
| Rate for Payer: Quartz Commercial |
$111.45
|
| 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 |
$107.54
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
Cardiolipin Antibody IgG & IgM
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
Cardiolipin Antibody IgG & IgM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$276.64 |
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| 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 |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$276.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$264.99
|
| Rate for Payer: HFN Commercial |
$276.64
|
| 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 |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$276.64
|
| Rate for Payer: Quartz Beloit One Network |
$128.13
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| 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 |
$160.16
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
Cardiolipin Antibody IgG & IgM
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
633698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| 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 |
$154.34
|
| 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 |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| 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 |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$189.28
|
| 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 |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
Cardiolipin Antibody IgM
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$185.74 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$185.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$177.92
|
| Rate for Payer: HFN Commercial |
$185.74
|
| 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 |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$185.74
|
| Rate for Payer: Quartz Beloit One Network |
$86.03
|
| Rate for Payer: Quartz Commercial |
$111.45
|
| 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 |
$107.54
|
| Rate for Payer: WPS Commercial |
$116.46
|
|
|
Cardiolipin Antibody IgM
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Cardiolipin Antibody IgM
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
2942867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| 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 |
$103.63
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.47
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| 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 |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.70
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| 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 |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: Wellcare Medicare |
$26.47
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$18,676.50
|
|
|
Service Code
|
APR-DRG 2054
|
| Min. Negotiated Rate |
$16,589.63 |
| Max. Negotiated Rate |
$18,676.50 |
| Rate for Payer: Anthem Medicaid |
$17,883.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,883.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,883.78
|
| Rate for Payer: Dean Health Medicaid |
$17,883.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,589.63
|
| Rate for Payer: Managed Health Services Medicaid |
$18,676.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,883.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,883.78
|
| Rate for Payer: United Healthcare Medicaid |
$17,883.78
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 2051
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$9,995.87
|
|
|
Service Code
|
APR-DRG 2053
|
| Min. Negotiated Rate |
$8,878.96 |
| Max. Negotiated Rate |
$9,995.87 |
| Rate for Payer: Anthem Medicaid |
$9,571.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,571.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,571.60
|
| Rate for Payer: Dean Health Medicaid |
$9,571.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,878.96
|
| Rate for Payer: Managed Health Services Medicaid |
$9,995.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,571.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,571.60
|
| Rate for Payer: United Healthcare Medicaid |
$9,571.60
|
|
|
CARDIOMYOPATHY
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 2052
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
CARDIOMYOPATHY DIAGNOSES
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00607
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Anthem Medicaid |
$90.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health Medicaid |
$90.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.71
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.71
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
|
|
CARDIOVASCULAR STRESS TEST 93015
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
CPT 93015
|
| Hospital Charge Code |
3015355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$476.22 |
| Rate for Payer: Aetna Commercial |
$476.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.10
|
| Rate for Payer: Aetna Managed Medicare |
$73.37
|
| Rate for Payer: Anthem Medicare Advantage |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.37
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cash Price |
$144.60
|
| Rate for Payer: Cigna Commercial |
$476.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.37
|
| Rate for Payer: Health EOS Commercial |
$456.16
|
| Rate for Payer: HFN Commercial |
$476.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$250.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.37
|
| Rate for Payer: Multiplan Commercial |
$401.02
|
| Rate for Payer: NAPHCARE Commercial |
$110.06
|
| Rate for Payer: Preferred Network Access Commercial |
$476.22
|
| Rate for Payer: Quartz Beloit One Network |
$220.56
|
| Rate for Payer: Quartz Commercial |
$285.73
|
| Rate for Payer: Quartz Medicare Advantage |
$73.37
|
| Rate for Payer: The Alliance Commercial |
$278.81
|
| Rate for Payer: United Healthcare Medicaid |
$95.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: WEA Trust Commercial |
$275.70
|
| Rate for Payer: WPS Commercial |
$293.49
|
|
|
Cardioversion
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3114196
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$588.06 |
| Max. Negotiated Rate |
$2,782.29 |
| Rate for Payer: Aetna Commercial |
$1,102.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,053.60
|
| Rate for Payer: Aetna Managed Medicare |
$695.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$796.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$612.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.06
|
| Rate for Payer: Anthem Medicare Advantage |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.57
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,127.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$685.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.57
|
| Rate for Payer: Health EOS Commercial |
$1,090.36
|
| Rate for Payer: HFN Commercial |
$1,127.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,587.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.57
|
| Rate for Payer: Multiplan Commercial |
$980.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.11
|
| Rate for Payer: Quartz Beloit One Network |
$600.31
|
| Rate for Payer: Quartz Commercial |
$796.33
|
| Rate for Payer: Quartz Medicare Advantage |
$695.57
|
| Rate for Payer: The Alliance Commercial |
$2,782.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.57
|
| Rate for Payer: WEA Trust Commercial |
$673.82
|
| Rate for Payer: Wellcare Medicare |
$695.57
|
| Rate for Payer: WPS Commercial |
$907.41
|
|
|
Cardioversion
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3114196
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$600.31 |
| Max. Negotiated Rate |
$1,127.11 |
| Rate for Payer: Aetna Commercial |
$1,102.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.31
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,127.11
|
| Rate for Payer: Health EOS Commercial |
$1,090.36
|
| Rate for Payer: HFN Commercial |
$1,127.11
|
| Rate for Payer: Multiplan Commercial |
$980.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.11
|
| Rate for Payer: Quartz Beloit One Network |
$600.31
|
| Rate for Payer: Quartz Commercial |
$735.07
|
| Rate for Payer: WEA Trust Commercial |
$673.82
|
| Rate for Payer: WPS Commercial |
$907.41
|
|
|
CARDIOVERSION
|
Facility
|
OP
|
$379.99
|
|
|
Service Code
|
EAPG 00093
|
| Min. Negotiated Rate |
$365.37 |
| Max. Negotiated Rate |
$379.99 |
| Rate for Payer: Anthem Medicaid |
$365.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$365.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$365.37
|
| Rate for Payer: Dean Health Medicaid |
$365.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$365.37
|
| Rate for Payer: Managed Health Services Medicaid |
$379.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$365.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$365.37
|
| Rate for Payer: United Healthcare Medicaid |
$365.37
|
|
|
Cardioversion Electric,EXT 92960
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
3227480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.96 |
| Max. Negotiated Rate |
$599.72 |
| Rate for Payer: Aetna Commercial |
$599.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Aetna Managed Medicare |
$93.96
|
| Rate for Payer: Anthem Medicare Advantage |
$93.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.96
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$599.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.96
|
| Rate for Payer: Health EOS Commercial |
$574.46
|
| Rate for Payer: HFN Commercial |
$599.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$383.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.96
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: NAPHCARE Commercial |
$140.95
|
| Rate for Payer: Preferred Network Access Commercial |
$599.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.76
|
| Rate for Payer: Quartz Commercial |
$359.83
|
| Rate for Payer: Quartz Medicare Advantage |
$93.96
|
| Rate for Payer: The Alliance Commercial |
$357.06
|
| Rate for Payer: United Healthcare Medicaid |
$249.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.96
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$375.86
|
|
|
Cardioversion Electric,EXT 9296026
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
CPT 92960 26
|
| Hospital Charge Code |
4634616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$249.56 |
| Max. Negotiated Rate |
$599.72 |
| Rate for Payer: Aetna Commercial |
$599.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$599.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.77
|
| Rate for Payer: Health EOS Commercial |
$574.46
|
| Rate for Payer: HFN Commercial |
$599.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$383.75
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: Preferred Network Access Commercial |
$599.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.76
|
| Rate for Payer: Quartz Commercial |
$359.83
|
| Rate for Payer: The Alliance Commercial |
$315.64
|
| Rate for Payer: United Healthcare Medicaid |
$249.56
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
Cardioversion Performed By
|
Facility
|
IP
|
$6,028.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
2844880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,071.87 |
| Max. Negotiated Rate |
$5,767.59 |
| Rate for Payer: Aetna Commercial |
$5,642.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,391.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,322.63
|
| Rate for Payer: Cash Price |
$1,808.40
|
| Rate for Payer: Cigna Commercial |
$5,767.59
|
| Rate for Payer: Health EOS Commercial |
$5,579.52
|
| Rate for Payer: HFN Commercial |
$5,767.59
|
| Rate for Payer: Multiplan Commercial |
$5,015.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,767.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,071.87
|
| Rate for Payer: Quartz Commercial |
$3,761.47
|
| Rate for Payer: WEA Trust Commercial |
$3,448.02
|
| Rate for Payer: WPS Commercial |
$4,643.37
|
|
|
Cardioversion Performed By
|
Facility
|
OP
|
$6,028.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
2844880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,767.59 |
| Rate for Payer: Aetna Commercial |
$5,642.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,391.44
|
| Rate for Payer: Aetna Managed Medicare |
$695.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,074.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,134.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,009.18
|
| Rate for Payer: Anthem Medicare Advantage |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,322.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.57
|
| 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 |
$5,767.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,508.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.57
|
| Rate for Payer: Health EOS Commercial |
$5,579.52
|
| Rate for Payer: HFN Commercial |
$5,767.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,587.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.57
|
| Rate for Payer: Multiplan Commercial |
$5,015.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,767.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,071.87
|
| Rate for Payer: Quartz Commercial |
$4,074.93
|
| Rate for Payer: Quartz Medicare Advantage |
$695.57
|
| Rate for Payer: The Alliance Commercial |
$2,782.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.57
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,448.02
|
| Rate for Payer: Wellcare Medicare |
$695.57
|
| Rate for Payer: WPS Commercial |
$4,643.37
|
|
|
CARE OF MISCARRIAGE 59820
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
3015170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$323.11 |
| Max. Negotiated Rate |
$1,453.98 |
| Rate for Payer: Aetna Commercial |
$1,443.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| Rate for Payer: Aetna Managed Medicare |
$323.11
|
| Rate for Payer: Anthem Medicare Advantage |
$323.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.11
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,443.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$338.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.11
|
| Rate for Payer: Health EOS Commercial |
$1,382.69
|
| Rate for Payer: HFN Commercial |
$1,443.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,281.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.11
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: NAPHCARE Commercial |
$484.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,443.47
|
| Rate for Payer: Quartz Beloit One Network |
$668.55
|
| Rate for Payer: Quartz Commercial |
$866.08
|
| Rate for Payer: Quartz Medicare Advantage |
$323.11
|
| Rate for Payer: The Alliance Commercial |
$1,373.21
|
| Rate for Payer: United Healthcare Medicaid |
$338.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.11
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,453.98
|
|
|
Carnitine Free and Total
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
977895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.12
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.32
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$70.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: United Healthcare PPO |
$331.50
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: Wellcare Medicare |
$17.54
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
|
Carnitine Free and Total
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
977895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.38
|
|
