|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$55,250.00
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$19,873.98 |
| Max. Negotiated Rate |
$55,250.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,873.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,009.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,966.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,319.90
|
| Rate for Payer: Anthem Medicare Advantage |
$19,873.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,873.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,873.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,873.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,767.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,873.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,887.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,873.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,873.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,873.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,873.98
|
| Rate for Payer: NAPHCARE Commercial |
$29,810.97
|
| Rate for Payer: Quartz Medicare Advantage |
$19,873.98
|
| Rate for Payer: The Alliance Commercial |
$55,250.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,873.98
|
| Rate for Payer: United Healthcare PPO |
$31,052.74
|
| Rate for Payer: Wellcare Medicare |
$19,873.98
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$81,152.00
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$29,191.51 |
| Max. Negotiated Rate |
$81,152.00 |
| Rate for Payer: Aetna Managed Medicare |
$29,191.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,422.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,313.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,000.64
|
| Rate for Payer: Anthem Medicare Advantage |
$29,191.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,191.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,191.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,191.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,844.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,191.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,169.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,191.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,191.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,191.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,191.51
|
| Rate for Payer: NAPHCARE Commercial |
$43,787.26
|
| Rate for Payer: Quartz Medicare Advantage |
$29,191.51
|
| Rate for Payer: The Alliance Commercial |
$81,152.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,191.51
|
| Rate for Payer: United Healthcare PPO |
$43,728.87
|
| Rate for Payer: Wellcare Medicare |
$29,191.51
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$40,455.00
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$14,552.00 |
| Max. Negotiated Rate |
$40,455.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,552.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,552.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,552.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,552.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,552.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,552.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,437.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,552.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,552.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,552.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,552.00
|
| Rate for Payer: NAPHCARE Commercial |
$21,828.00
|
| Rate for Payer: Quartz Medicare Advantage |
$14,552.00
|
| Rate for Payer: The Alliance Commercial |
$40,455.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,552.00
|
| Rate for Payer: United Healthcare PPO |
$22,917.24
|
| Rate for Payer: Wellcare Medicare |
$14,552.00
|
|
|
CHOLEDOCHOSCOPY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2959928
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.64 |
| Max. Negotiated Rate |
$26,852.00 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.59
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.75
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,363.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.80
|
| Rate for Payer: The Alliance Commercial |
$26,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
CHOLEDOCHOSCOPY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2959928
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,289.37 |
| Max. Negotiated Rate |
$6,175.96 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,027.80
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
CHOLESTECH MULTI-ANALYTE CNTRL
|
Facility
|
IP
|
$1,395.00
|
|
| Hospital Charge Code |
2969875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$683.55 |
| Max. Negotiated Rate |
$1,283.40 |
| Rate for Payer: Aetna Commercial |
$1,255.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,199.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.35
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$1,283.40
|
| Rate for Payer: Health EOS Commercial |
$1,241.55
|
| Rate for Payer: HFN Commercial |
$1,283.40
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: NAPHCARE Commercial |
$837.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,283.40
|
| Rate for Payer: Quartz Beloit One Network |
$683.55
|
| Rate for Payer: Quartz Commercial |
$837.00
|
| Rate for Payer: WEA Trust Commercial |
$767.25
|
| Rate for Payer: WPS Commercial |
$1,033.28
|
|
|
CHOLESTECH MULTI-ANALYTE CNTRL
|
Facility
|
OP
|
$1,395.00
|
|
| Hospital Charge Code |
2969875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$5,580.00 |
| Rate for Payer: Aetna Commercial |
$1,255.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,199.70
|
| Rate for Payer: Aetna Managed Medicare |
$390.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$906.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$697.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$669.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$739.35
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$1,283.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$780.64
|
| Rate for Payer: Health EOS Commercial |
$1,241.55
|
| Rate for Payer: HFN Commercial |
$1,283.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,046.25
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: NAPHCARE Commercial |
$837.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,283.40
|
| Rate for Payer: Quartz Beloit One Network |
$683.55
|
| Rate for Payer: Quartz Commercial |
$906.75
|
| Rate for Payer: Quartz Medicare Advantage |
$837.00
|
| Rate for Payer: The Alliance Commercial |
$5,580.00
|
| Rate for Payer: WEA Trust Commercial |
$767.25
|
| Rate for Payer: WPS Commercial |
$1,033.28
|
|
|
CHOLESTEROL AND GLUCOSE TOTAL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2971691
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
CHOLESTEROL AND GLUCOSE TOTAL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2971691
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| 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: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| 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 |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Cholesterol High Density Lipid
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.40
|
| Rate for Payer: Health EOS Commercial |
$117.39
|
| Rate for Payer: HFN Commercial |
$122.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$122.55
|
| Rate for Payer: Quartz Beloit One Network |
$56.76
|
| Rate for Payer: Quartz Commercial |
$73.53
|
| Rate for Payer: The Alliance Commercial |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Cholesterol High Density Lipid
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Cholesterol High Density Lipid
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.60
|
| Rate for Payer: Anthem Medicaid |
$8.46
|
| Rate for Payer: Anthem Medicare Advantage |
$8.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.19
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.19
|
| Rate for Payer: Dean Health Medicaid |
$8.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.19
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$12.28
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.46
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$8.19
|
| Rate for Payer: The Alliance Commercial |
$32.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.19
|
| Rate for Payer: United Healthcare PPO |
$96.75
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: Wellcare Medicare |
$8.19
|
| Rate for Payer: WMAP Medicaid |
$8.46
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Cholesterol, Pleural Fluid
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4163505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Cholesterol, Pleural Fluid
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4163505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.00
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Cholesterol, Pleural Fluid
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4163505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.45
|
| Rate for Payer: Anthem Medicaid |
$8.37
|
| Rate for Payer: Anthem Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.10
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Dean Health Medicaid |
$8.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.10
|
| Rate for Payer: Managed Health Services Medicaid |
$8.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.15
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.37
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$32.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$8.10
|
| Rate for Payer: WMAP Medicaid |
$8.37
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Cholesterol Total
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
633705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Cholesterol Total
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
633705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.60
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: HFN Commercial |
$72.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.36
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: The Alliance Commercial |
$38.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Cholesterol Total
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
633705
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$4.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.22
|
| Rate for Payer: Anthem Medicaid |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.35
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.53
|
| Rate for Payer: Dean Health Medicaid |
$4.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.35
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.35
|
| Rate for Payer: Managed Health Services Medicaid |
$4.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.52
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.49
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4.35
|
| Rate for Payer: The Alliance Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicaid |
$4.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$4.35
|
| Rate for Payer: WMAP Medicaid |
$4.49
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
CHOLINESTERASE INHIBITOR CHALLENGE TEST 95857
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 95857
|
| Hospital Charge Code |
3015469
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$289.75 |
| Rate for Payer: Aetna Commercial |
$289.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$289.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.00
|
| Rate for Payer: Health EOS Commercial |
$277.55
|
| Rate for Payer: HFN Commercial |
$289.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$189.74
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.75
|
| Rate for Payer: Quartz Beloit One Network |
$134.20
|
| Rate for Payer: Quartz Commercial |
$173.85
|
| Rate for Payer: The Alliance Commercial |
$152.50
|
| Rate for Payer: United Healthcare Medicaid |
$37.90
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
CHONDROCYTES MACI AUTOLOGOUS CULTURED 81073
|
Facility
|
OP
|
$54,750.00
|
|
|
Service Code
|
HCPCS J7330
|
| Hospital Charge Code |
5307123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,330.00 |
| Max. Negotiated Rate |
$219,000.00 |
| Rate for Payer: Aetna Commercial |
$49,275.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,085.00
|
| Rate for Payer: Aetna Managed Medicare |
$15,330.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,587.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,375.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,280.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,017.50
|
| Rate for Payer: Cash Price |
$16,425.00
|
| Rate for Payer: Cigna Commercial |
$50,370.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,638.10
|
| Rate for Payer: Health EOS Commercial |
$48,727.50
|
| Rate for Payer: HFN Commercial |
$50,370.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,062.50
|
| Rate for Payer: Multiplan Commercial |
$43,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$32,850.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50,370.00
|
| Rate for Payer: Quartz Beloit One Network |
$26,827.50
|
| Rate for Payer: Quartz Commercial |
$35,587.50
|
| Rate for Payer: Quartz Medicare Advantage |
$32,850.00
|
| Rate for Payer: The Alliance Commercial |
$219,000.00
|
| Rate for Payer: WEA Trust Commercial |
$30,112.50
|
| Rate for Payer: WPS Commercial |
$40,553.32
|
|
|
CHONDROCYTES MACI AUTOLOGOUS CULTURED 81073
|
Facility
|
IP
|
$54,750.00
|
|
|
Service Code
|
HCPCS J7330
|
| Hospital Charge Code |
5307123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,827.50 |
| Max. Negotiated Rate |
$50,370.00 |
| Rate for Payer: Aetna Commercial |
$49,275.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,085.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,017.50
|
| Rate for Payer: Cash Price |
$16,425.00
|
| Rate for Payer: Cigna Commercial |
$50,370.00
|
| Rate for Payer: Health EOS Commercial |
$48,727.50
|
| Rate for Payer: HFN Commercial |
$50,370.00
|
| Rate for Payer: Multiplan Commercial |
$43,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$32,850.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50,370.00
|
| Rate for Payer: Quartz Beloit One Network |
$26,827.50
|
| Rate for Payer: Quartz Commercial |
$32,850.00
|
| Rate for Payer: WEA Trust Commercial |
$30,112.50
|
| Rate for Payer: WPS Commercial |
$40,553.32
|
|
|
Chromatin (Nucleosomal) Antibody
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3403546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| 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 |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| 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 |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| 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 |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Chromatin (Nucleosomal) Antibody
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4606710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$60.75
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Chromatin (Nucleosomal) Antibody
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4606710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.60
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: HFN Commercial |
$76.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Chromatin (Nucleosomal) Antibody
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
3403546
|
|
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
|
|
