|
Additional 30 min Increments, Critical Care >74 min - 99292
|
Facility
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
5516692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,685.44 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.52
|
| Rate for Payer: Aetna Managed Medicare |
$512.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,190.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$879.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.19
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,190.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,099.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
Additional 30 min Increments, Critical Care >74 min - 99292
|
Facility
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
5516692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.68 |
| Max. Negotiated Rate |
$1,685.44 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,099.20
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
Additional IV Push Same Drug
|
Facility
OP
|
$199.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
3040223
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$55.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$119.40
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Additional IV Push Same Drug
|
Facility
IP
|
$199.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
3040223
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Additional IV Push Same Drug - 96376
|
Facility
IP
|
$199.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
5516712
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Additional IV Push Same Drug - 96376
|
Facility
OP
|
$199.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
5516712
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$55.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$119.40
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Additional Push Of Medication
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
3040222
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.32
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Additional Push Of Medication
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
3040222
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Additional Push of Medication - 96375
|
Facility
IP
|
$234.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
5516711
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Additional Push of Medication - 96375
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
5516711
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.32
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Add'l 30 Min Increments CC > 74
|
Facility
OP
|
$1,832.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
2472469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,685.44 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.52
|
| Rate for Payer: Aetna Managed Medicare |
$512.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,190.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$879.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.19
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,374.00
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,190.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,099.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
Add'l 30 Min Increments CC > 74
|
Facility
IP
|
$1,832.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
2472469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.68 |
| Max. Negotiated Rate |
$1,685.44 |
| Rate for Payer: Aetna Commercial |
$1,648.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$970.96
|
| Rate for Payer: Cash Price |
$549.60
|
| Rate for Payer: Cigna Commercial |
$1,685.44
|
| Rate for Payer: Health EOS Commercial |
$1,630.48
|
| Rate for Payer: HFN Commercial |
$1,685.44
|
| Rate for Payer: Multiplan Commercial |
$1,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.44
|
| Rate for Payer: Quartz Beloit One Network |
$897.68
|
| Rate for Payer: Quartz Commercial |
$1,099.20
|
| Rate for Payer: WEA Trust Commercial |
$1,007.60
|
| Rate for Payer: WPS Commercial |
$1,356.96
|
|
|
Addtl Enteric Organism Charge
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
1676799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$9.44
|
| Rate for Payer: Anthem Medicare Advantage |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.44
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.44
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9.44
|
| Rate for Payer: The Alliance Commercial |
$37.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$41.54
|
|
|
Addtl Enteric Organism Charge
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
1676799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Addtl Enteric Organism Charge
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
1676799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$9.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.67
|
| Rate for Payer: Anthem Medicaid |
$3.40
|
| Rate for Payer: Anthem Medicare Advantage |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.44
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.40
|
| Rate for Payer: Dean Health Medicaid |
$3.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.44
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.44
|
| Rate for Payer: Managed Health Services Medicaid |
$3.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$14.16
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.40
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9.44
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: Wellcare Medicare |
$9.44
|
| Rate for Payer: WMAP Medicaid |
$3.40
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
ADENOIDECTOMY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ADENOIDECTOMY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
OP
|
$11,838.12
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$11,838.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$7,251.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
Adenosine Deaminase, Pleural Fluid
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5314317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| 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 |
$91.16
|
| 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 |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| 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 Medicaid |
$8.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| 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 |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.15
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.37
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: United Healthcare PPO |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: Wellcare Medicare |
$8.10
|
| Rate for Payer: WMAP Medicaid |
$8.37
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Adenosine Deaminase, Pleural Fluid
|
Professional
|
$172.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5314317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$8.10
|
| Rate for Payer: Anthem Medicare Advantage |
$8.10
|
| 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 |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$163.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$156.52
|
| 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: Independent Care Health Plan Medicare |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Preferred Network Access Commercial |
$163.40
|
| Rate for Payer: Quartz Beloit One Network |
$75.68
|
| Rate for Payer: Quartz Commercial |
$98.04
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$35.64
|
|
|
Adenosine Deaminase, Pleural Fluid
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5314317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Adenovirus Ag, Stool, EIA
|
Professional
|
$151.00
|
|
|
Service Code
|
CPT 87301
|
| Hospital Charge Code |
980013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
Adenovirus Ag, Stool, EIA
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
CPT 87301
|
| Hospital Charge Code |
980013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Adenovirus Ag, Stool, EIA
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
CPT 87301
|
| Hospital Charge Code |
980013
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Adenovirus Antibody
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
980014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| 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
|
|
