|
CF DNA Amplification 83901
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Amplification 83901
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Amplification 83901
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Isolation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Isolation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Isolation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Mutation ID
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Mutation ID
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Mutation ID
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Separation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Separation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF Separation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CGMS, patient own 95249
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
6182372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.47 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna Commercial |
$301.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$301.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.20
|
| Rate for Payer: Health EOS Commercial |
$288.47
|
| Rate for Payer: HFN Commercial |
$301.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$301.15
|
| Rate for Payer: Quartz Beloit One Network |
$139.48
|
| Rate for Payer: Quartz Commercial |
$180.69
|
| Rate for Payer: The Alliance Commercial |
$158.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.47
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
CGMS SOF-SENSOR GLUCOSE
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
2973575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$845.48 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$551.40
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$551.40
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
CGMS SOF-SENSOR GLUCOSE
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
2973575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$3,676.00 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.34
|
| Rate for Payer: Aetna Managed Medicare |
$257.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.27
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.25
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$551.40
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$597.35
|
| Rate for Payer: Quartz Medicare Advantage |
$551.40
|
| Rate for Payer: The Alliance Commercial |
$3,676.00
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
CHALAZION REMOVAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959923
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
CHALAZION REMOVAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959923
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Changed (dressing)* - Central IV Dressing:
|
Facility
|
IP
|
$386.00
|
|
| Hospital Charge Code |
4075885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Changed (dressing)* - Central IV Dressing:
|
Facility
|
OP
|
$386.00
|
|
| Hospital Charge Code |
4075885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$108.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.01
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$231.60
|
| Rate for Payer: The Alliance Commercial |
$1,544.00
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Change of Bladder Tube 51705
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3595523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: HFN Commercial |
$498.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.73
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
Change of Bladder Tube 51705PP
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3439519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: HFN Commercial |
$498.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.73
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
Change of Cystostomy Tube; Complicated
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
1188970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Aetna Commercial |
$944.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.84
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$944.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.40
|
| Rate for Payer: Health EOS Commercial |
$904.54
|
| Rate for Payer: HFN Commercial |
$944.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.57
|
| Rate for Payer: Multiplan Commercial |
$795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$944.30
|
| Rate for Payer: Quartz Beloit One Network |
$437.36
|
| Rate for Payer: Quartz Commercial |
$566.58
|
| Rate for Payer: The Alliance Commercial |
$497.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.65
|
| Rate for Payer: WEA Trust Commercial |
$546.70
|
| Rate for Payer: WPS Commercial |
$736.26
|
|
|
Change of Cystostomy Tube; simple
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
1188969
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna Commercial |
$426.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$426.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.40
|
| Rate for Payer: Health EOS Commercial |
$408.59
|
| Rate for Payer: HFN Commercial |
$426.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.73
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$426.55
|
| Rate for Payer: Quartz Beloit One Network |
$197.56
|
| Rate for Payer: Quartz Commercial |
$255.93
|
| Rate for Payer: The Alliance Commercial |
$224.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
|
|
Change Of Gastrostomy Tube, Percutaneous, Without Imaging Or Contrast
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
1190853
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.20
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: HFN Commercial |
$201.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: The Alliance Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicaid |
$173.15
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
