|
CF DNA Amplification 83901
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Amplification 83901
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2848799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Isolation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Isolation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF DNA Isolation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Mutation ID
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Mutation ID
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Mutation ID
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Separation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Separation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CF Separation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2792801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
CGMS, patient own 95249
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 95249
|
| Hospital Charge Code |
6182372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$68.65
|
| Rate for Payer: Anthem Medicare Advantage |
$68.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.65
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$313.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.65
|
| Rate for Payer: Health EOS Commercial |
$300.01
|
| Rate for Payer: HFN Commercial |
$313.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.65
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$102.98
|
| Rate for Payer: Preferred Network Access Commercial |
$313.20
|
| Rate for Payer: Quartz Beloit One Network |
$145.06
|
| Rate for Payer: Quartz Commercial |
$187.92
|
| Rate for Payer: Quartz Medicare Advantage |
$68.65
|
| Rate for Payer: The Alliance Commercial |
$171.63
|
| Rate for Payer: United Healthcare Medicaid |
$44.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.65
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$274.60
|
|
|
CGMS SOF-SENSOR GLUCOSE
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
2973575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.61 |
| Max. Negotiated Rate |
$879.30 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Aetna Managed Medicare |
$267.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$621.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.86
|
| Rate for Payer: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.82
|
| Rate for Payer: Multiplan Commercial |
$764.61
|
| Rate for Payer: NAPHCARE Commercial |
$573.46
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$621.24
|
| Rate for Payer: Quartz Medicare Advantage |
$573.46
|
| Rate for Payer: The Alliance Commercial |
$477.88
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
CGMS SOF-SENSOR GLUCOSE
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
2973575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$879.30 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| Rate for Payer: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| Rate for Payer: Multiplan Commercial |
$764.61
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$573.46
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
CHALAZION REMOVAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959923
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CHALAZION REMOVAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959923
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Changed (dressing)* - Central IV Dressing:
|
Facility
|
OP
|
$386.00
|
|
| Hospital Charge Code |
4075885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$112.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.65
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.08
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$240.86
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$260.94
|
| Rate for Payer: Quartz Medicare Advantage |
$240.86
|
| Rate for Payer: The Alliance Commercial |
$200.72
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
Changed (dressing)* - Central IV Dressing:
|
Facility
|
IP
|
$386.00
|
|
| Hospital Charge Code |
4075885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$240.86
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
Change of Bladder Tube 51705
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3595523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$45.50
|
| Rate for Payer: Anthem Medicare Advantage |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.50
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: HFN Commercial |
$518.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$68.25
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: Quartz Medicare Advantage |
$45.50
|
| Rate for Payer: The Alliance Commercial |
$193.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.50
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$204.75
|
|
|
Change of Bladder Tube 51705PP
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3439519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$45.50
|
| Rate for Payer: Anthem Medicare Advantage |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.50
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: HFN Commercial |
$518.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$68.25
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: Quartz Medicare Advantage |
$45.50
|
| Rate for Payer: The Alliance Commercial |
$193.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.50
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$204.75
|
|
|
Change of Cystostomy Tube; Complicated
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
1188970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$982.07 |
| Rate for Payer: Aetna Commercial |
$982.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.03
|
| Rate for Payer: Aetna Managed Medicare |
$70.97
|
| Rate for Payer: Anthem Medicare Advantage |
$70.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.97
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$982.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.97
|
| Rate for Payer: Health EOS Commercial |
$940.72
|
| Rate for Payer: HFN Commercial |
$982.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.97
|
| Rate for Payer: Multiplan Commercial |
$827.01
|
| Rate for Payer: NAPHCARE Commercial |
$106.45
|
| Rate for Payer: Preferred Network Access Commercial |
$982.07
|
| Rate for Payer: Quartz Beloit One Network |
$454.85
|
| Rate for Payer: Quartz Commercial |
$589.24
|
| Rate for Payer: Quartz Medicare Advantage |
$70.97
|
| Rate for Payer: The Alliance Commercial |
$301.62
|
| Rate for Payer: United Healthcare Medicaid |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.97
|
| Rate for Payer: WEA Trust Commercial |
$568.57
|
| Rate for Payer: WPS Commercial |
$319.36
|
|
|
Change of Cystostomy Tube; simple
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
1188969
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$443.61 |
| Rate for Payer: Aetna Commercial |
$443.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$45.50
|
| Rate for Payer: Anthem Medicare Advantage |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.50
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$443.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.50
|
| Rate for Payer: Health EOS Commercial |
$424.93
|
| Rate for Payer: HFN Commercial |
$443.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$68.25
|
| Rate for Payer: Preferred Network Access Commercial |
$443.61
|
| Rate for Payer: Quartz Beloit One Network |
$205.46
|
| Rate for Payer: Quartz Commercial |
$266.17
|
| Rate for Payer: Quartz Medicare Advantage |
$45.50
|
| Rate for Payer: The Alliance Commercial |
$193.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.50
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$204.75
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
|
|
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 |
$31.96 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$31.96
|
| Rate for Payer: Anthem Medicare Advantage |
$31.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.96
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.96
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.96
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$47.94
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$31.96
|
| Rate for Payer: The Alliance Commercial |
$135.83
|
| Rate for Payer: United Healthcare Medicaid |
$180.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.96
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$143.82
|
|
|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
