|
CCC Observation Per Hour
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040434
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
CCC Pulmonary Capillary Wedge Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
3715550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.46 |
| Max. Negotiated Rate |
$325.68 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$212.40
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
CCC Pulmonary Capillary Wedge Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
OP
|
$354.00
|
|
| Hospital Charge Code |
3715550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$99.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.10
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$230.10
|
| Rate for Payer: Quartz Medicare Advantage |
$212.40
|
| Rate for Payer: The Alliance Commercial |
$1,416.00
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
CCPD Completed Training Day
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215531
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$7,616.00 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: The Alliance Commercial |
$7,616.00
|
| Rate for Payer: United Healthcare PPO |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CCPD Completed Training Day
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215531
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CCPD Inpatient
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
3603560
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$712.95 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
CCPD Inpatient
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
3603560
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$5,820.00 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.25
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$945.75
|
| Rate for Payer: Quartz Medicare Advantage |
$873.00
|
| Rate for Payer: The Alliance Commercial |
$5,820.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
CCPD Method I
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005581
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$416.01 |
| Max. Negotiated Rate |
$1,751.08 |
| Rate for Payer: Aetna Commercial |
$764.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.14
|
| Rate for Payer: Aetna Managed Medicare |
$437.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$699.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.00
|
| Rate for Payer: Anthem Medicare Advantage |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$437.77
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$781.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$437.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$437.77
|
| Rate for Payer: Health EOS Commercial |
$755.61
|
| Rate for Payer: HFN Commercial |
$781.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,628.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$437.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$437.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$437.77
|
| Rate for Payer: Multiplan Commercial |
$679.20
|
| Rate for Payer: NAPHCARE Commercial |
$656.66
|
| Rate for Payer: Preferred Network Access Commercial |
$781.08
|
| Rate for Payer: Quartz Beloit One Network |
$416.01
|
| Rate for Payer: Quartz Commercial |
$551.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.77
|
| Rate for Payer: The Alliance Commercial |
$1,751.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare PPO |
$636.75
|
| Rate for Payer: WEA Trust Commercial |
$466.95
|
| Rate for Payer: Wellcare Medicare |
$437.77
|
| Rate for Payer: WPS Commercial |
$628.85
|
|
|
CCPD Method I
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005581
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$416.01 |
| Max. Negotiated Rate |
$781.08 |
| Rate for Payer: Aetna Commercial |
$764.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$781.08
|
| Rate for Payer: Health EOS Commercial |
$755.61
|
| Rate for Payer: HFN Commercial |
$781.08
|
| Rate for Payer: Multiplan Commercial |
$679.20
|
| Rate for Payer: NAPHCARE Commercial |
$509.40
|
| Rate for Payer: Preferred Network Access Commercial |
$781.08
|
| Rate for Payer: Quartz Beloit One Network |
$416.01
|
| Rate for Payer: Quartz Commercial |
$509.40
|
| Rate for Payer: WEA Trust Commercial |
$466.95
|
| Rate for Payer: WPS Commercial |
$628.85
|
|
|
CCPD Support Method 2
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603559
|
|
Hospital Revenue Code
|
855
|
| Min. Negotiated Rate |
$437.77 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.94
|
| Rate for Payer: Aetna Managed Medicare |
$437.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.92
|
| Rate for Payer: Anthem Medicare Advantage |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$437.77
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$437.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,814.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$437.77
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,628.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$437.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$437.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$437.77
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$656.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,268.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.77
|
| Rate for Payer: The Alliance Commercial |
$1,751.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare PPO |
$3,771.75
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: Wellcare Medicare |
$437.77
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
CCPD Support Method 2
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603559
|
|
Hospital Revenue Code
|
855
|
| Min. Negotiated Rate |
$2,464.21 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,017.40
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
CCPD Training per Day
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3005583
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CCPD Training per Day
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3005583
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$7,616.00 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: The Alliance Commercial |
$7,616.00
|
| Rate for Payer: United Healthcare PPO |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CD19, CD20 to Mayo
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4620679
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$133.19 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
CD19, CD20 to Mayo
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4620679
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$150.92
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
CD19, CD20 to Mayo
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4620679
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
CD4/CD8 Ratio
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
4746614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$165.84 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
CD4/CD8 Ratio
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
4746614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
CD4/CD8 Ratio
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
4746614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$187.92 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$46.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.99
|
| Rate for Payer: Anthem Medicaid |
$48.54
|
| Rate for Payer: Anthem Medicare Advantage |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.98
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Dean Health Medicaid |
$48.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.98
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.98
|
| Rate for Payer: Managed Health Services Medicaid |
$50.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.98
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$70.47
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.54
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.98
|
| Rate for Payer: The Alliance Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicaid |
$48.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: Wellcare Medicare |
$46.98
|
| Rate for Payer: WMAP Medicaid |
$48.54
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.80
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: HFN Commercial |
$93.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: The Alliance Commercial |
$49.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
C diff 027-NAP1-BI
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
C diff 027-NAP1-BI
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
C diff 027-NAP1-BI
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.87
|
| Rate for Payer: Anthem Medicaid |
$38.51
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicaid |
$40.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.51
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicaid |
$38.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WMAP Medicaid |
$38.51
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
