|
Acid Fast Stain Report
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
634214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Acid Fast Stain Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
634214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$114.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.60
|
| Rate for Payer: Health EOS Commercial |
$110.11
|
| Rate for Payer: HFN Commercial |
$114.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.95
|
| Rate for Payer: Quartz Beloit One Network |
$53.24
|
| Rate for Payer: Quartz Commercial |
$68.97
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Acne Surgery 10040
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
1188872
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: HFN Commercial |
$275.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.69
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: United Healthcare Medicaid |
$22.91
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Acorn Nebulizer Kit
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040339
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Acorn Nebulizer Kit
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040339
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Acoustic Reflex Testing; Threshold
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
1230806
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Acoustic Reflex Testing; Threshold
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
1230806
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.70
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Acoustic Reflex Testing; Threshold
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
1230806
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: The Alliance Commercial |
$158.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Acromio/clavicular canvas&we L3670
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Acromio/clavicular canvas&we L3670
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.12 |
| Max. Negotiated Rate |
$366.63 |
| Rate for Payer: Aetna Commercial |
$211.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$211.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.80
|
| Rate for Payer: Health EOS Commercial |
$202.93
|
| Rate for Payer: HFN Commercial |
$211.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$366.63
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$211.85
|
| Rate for Payer: Quartz Beloit One Network |
$98.12
|
| Rate for Payer: Quartz Commercial |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$111.50
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Acromio/clavicular canvas&we L3670
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL LIGAMENT RELEASE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 23130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
ACTH Stimulation, 2 Specimens
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.06
|
| Rate for Payer: Anthem Medicaid |
$16.84
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Dean Health Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$24.45
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.84
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$65.20
|
| Rate for Payer: United Healthcare Medicaid |
$16.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare PPO |
$90.75
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: Wellcare Medicare |
$16.30
|
| Rate for Payer: WMAP Medicaid |
$16.84
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
ACTH Stimulation, 2 Specimens
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$114.95 |
| Rate for Payer: Aetna Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$114.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.60
|
| Rate for Payer: Health EOS Commercial |
$110.11
|
| Rate for Payer: HFN Commercial |
$114.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.54
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Preferred Network Access Commercial |
$114.95
|
| Rate for Payer: Quartz Beloit One Network |
$53.24
|
| Rate for Payer: Quartz Commercial |
$68.97
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
ACTH Stimulation, 2 Specimens
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
ACTH Stimulation, 3 Specimens
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
ACTH Stimulation, 3 Specimens
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.06
|
| Rate for Payer: Anthem Medicaid |
$16.84
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Dean Health Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.45
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.84
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$65.20
|
| Rate for Payer: United Healthcare Medicaid |
$16.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$16.30
|
| Rate for Payer: WMAP Medicaid |
$16.84
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
ACTH Stimulation, 3 Specimens
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.54
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Actigraphy Monitoring
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$309.19 |
| Max. Negotiated Rate |
$580.52 |
| Rate for Payer: Aetna Commercial |
$567.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.43
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$580.52
|
| Rate for Payer: Health EOS Commercial |
$561.59
|
| Rate for Payer: HFN Commercial |
$580.52
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: NAPHCARE Commercial |
$378.60
|
| Rate for Payer: Preferred Network Access Commercial |
$580.52
|
| Rate for Payer: Quartz Beloit One Network |
$309.19
|
| Rate for Payer: Quartz Commercial |
$378.60
|
| Rate for Payer: WEA Trust Commercial |
$347.05
|
| Rate for Payer: WPS Commercial |
$467.38
|
|
|
Actigraphy Monitoring
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$567.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.66
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$580.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$561.59
|
| Rate for Payer: HFN Commercial |
$580.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$580.52
|
| Rate for Payer: Quartz Beloit One Network |
$309.19
|
| Rate for Payer: Quartz Commercial |
$410.15
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$473.25
|
| Rate for Payer: WEA Trust Commercial |
$347.05
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$467.38
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.60
|
| Rate for Payer: Health EOS Commercial |
$50.96
|
| Rate for Payer: HFN Commercial |
$53.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.20
|
| Rate for Payer: Quartz Beloit One Network |
$24.64
|
| Rate for Payer: Quartz Commercial |
$31.92
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Activated Protein C Resistance
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$193.80
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Activated Protein C Resistance
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.80
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: HFN Commercial |
$306.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: The Alliance Commercial |
$161.50
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
