|
CPAP Titration
|
Facility
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103327
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| 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 |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,291.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,984.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,751.00
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
CPAP Titration
|
Facility
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103327
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,757.32 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,600.80
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
C-Peptide
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$145.20
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$145.20
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
C-Peptide
|
Professional
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$229.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$220.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$229.90
|
| Rate for Payer: Quartz Beloit One Network |
$106.48
|
| Rate for Payer: Quartz Commercial |
$137.94
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$82.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$91.56
|
|
|
C-Peptide
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
977884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$7.34
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.34
|
| Rate for Payer: Dean Health Medicaid |
$7.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$7.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.34
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$968.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$7.34
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
C PLATE HALLU LOCK SZ 0 RT 290335SND
|
Facility
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,229.92 |
| Max. Negotiated Rate |
$7,326.88 |
| Rate for Payer: Aetna Commercial |
$7,167.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,849.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,229.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,176.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,982.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,822.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,220.92
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,326.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,456.65
|
| Rate for Payer: Health EOS Commercial |
$7,087.96
|
| Rate for Payer: HFN Commercial |
$7,326.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,973.00
|
| Rate for Payer: Multiplan Commercial |
$6,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,778.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,326.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,902.36
|
| Rate for Payer: Quartz Commercial |
$5,176.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,778.40
|
| Rate for Payer: WEA Trust Commercial |
$4,380.20
|
| Rate for Payer: WPS Commercial |
$5,898.93
|
|
|
C PLATE HALLU LOCK SZ 0 RT 290335SND
|
Facility
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,902.36 |
| Max. Negotiated Rate |
$7,326.88 |
| Rate for Payer: Aetna Commercial |
$7,167.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,220.92
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,326.88
|
| Rate for Payer: Health EOS Commercial |
$7,087.96
|
| Rate for Payer: HFN Commercial |
$7,326.88
|
| Rate for Payer: Multiplan Commercial |
$6,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,778.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,326.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,902.36
|
| Rate for Payer: Quartz Commercial |
$4,778.40
|
| Rate for Payer: WEA Trust Commercial |
$4,380.20
|
| Rate for Payer: WPS Commercial |
$5,898.93
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Professional
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$299.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$299.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.00
|
| Rate for Payer: Health EOS Commercial |
$286.65
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$299.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.60
|
| Rate for Payer: Quartz Commercial |
$179.55
|
| Rate for Payer: The Alliance Commercial |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Facility
IP
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
CPM Rental - PT Equipment Issued Rehab
|
Facility
OP
|
$315.00
|
|
| Hospital Charge Code |
2989877
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$88.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.27
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$189.00
|
| Rate for Payer: The Alliance Commercial |
$1,260.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
CPR
|
Facility
IP
|
$1,371.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3052469
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$671.79 |
| Max. Negotiated Rate |
$1,261.32 |
| Rate for Payer: Quartz Commercial |
$822.60
|
| Rate for Payer: Aetna Commercial |
$1,233.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.63
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,261.32
|
| Rate for Payer: Health EOS Commercial |
$1,220.19
|
| Rate for Payer: HFN Commercial |
$1,261.32
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$822.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,261.32
|
| Rate for Payer: Quartz Beloit One Network |
$671.79
|
| Rate for Payer: WEA Trust Commercial |
$754.05
|
| Rate for Payer: WPS Commercial |
$1,015.50
|
|
|
CPR
|
Facility
OP
|
$1,371.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3052469
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,261.32 |
| Rate for Payer: Aetna Commercial |
$1,233.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.06
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$891.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.08
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,261.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,220.19
|
| Rate for Payer: HFN Commercial |
$1,261.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,261.32
|
| Rate for Payer: Quartz Beloit One Network |
$671.79
|
| Rate for Payer: Quartz Commercial |
$891.15
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: WEA Trust Commercial |
$754.05
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,015.50
|
|
|
CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS 20985
|
Professional
|
$1,810.00
|
|
|
Service Code
|
CPT 20985
|
| Hospital Charge Code |
6250435
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.27 |
| Max. Negotiated Rate |
$1,719.50 |
| Rate for Payer: Aetna Commercial |
$1,719.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,556.60
|
| Rate for Payer: Aetna Managed Medicare |
$131.67
|
| Rate for Payer: Anthem Medicare Advantage |
$131.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.67
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cash Price |
$543.00
|
| Rate for Payer: Cigna Commercial |
$1,719.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$905.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.67
|
| Rate for Payer: Health EOS Commercial |
$1,647.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$473.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$473.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.67
|
| Rate for Payer: Multiplan Commercial |
$1,448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,719.50
|
| Rate for Payer: Quartz Beloit One Network |
$796.40
|
| Rate for Payer: Quartz Commercial |
$1,031.70
|
| Rate for Payer: Quartz Medicare Advantage |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$559.60
|
| Rate for Payer: United Healthcare Medicaid |
$104.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.67
|
| Rate for Payer: WEA Trust Commercial |
$995.50
|
| Rate for Payer: WPS Commercial |
$592.52
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
IP
|
$40,545.00
|
|
|
Service Code
|
MS-DRG 073
|
| Min. Negotiated Rate |
$14,584.53 |
| Max. Negotiated Rate |
$40,545.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,584.53
|
| 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 |
$14,584.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,584.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,584.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,584.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,584.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,503.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,584.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,584.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,584.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,584.53
|
| Rate for Payer: NAPHCARE Commercial |
$21,876.80
|
| Rate for Payer: Quartz Medicare Advantage |
$14,584.53
|
| Rate for Payer: The Alliance Commercial |
$40,545.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,584.53
|
| Rate for Payer: United Healthcare PPO |
$22,968.85
|
| Rate for Payer: Wellcare Medicare |
$14,584.53
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
IP
|
$27,603.00
|
|
|
Service Code
|
MS-DRG 074
|
| Min. Negotiated Rate |
$9,929.12 |
| Max. Negotiated Rate |
$27,603.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,929.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$9,929.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,929.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,929.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,929.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,929.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,010.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,929.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,929.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,929.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,929.12
|
| Rate for Payer: NAPHCARE Commercial |
$14,893.68
|
| Rate for Payer: Quartz Medicare Advantage |
$9,929.12
|
| Rate for Payer: The Alliance Commercial |
$27,603.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,929.12
|
| Rate for Payer: United Healthcare PPO |
$15,578.74
|
| Rate for Payer: Wellcare Medicare |
$9,929.12
|
|
|
CRANIOFACIAL RECONSTRUCTION
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959954
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
CRANIOFACIAL RECONSTRUCTION
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959954
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
IP
|
$78,831.00
|
|
|
Service Code
|
MS-DRG 026
|
| Min. Negotiated Rate |
$28,356.64 |
| Max. Negotiated Rate |
$78,831.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,356.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,891.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47,438.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,070.10
|
| Rate for Payer: Anthem Medicare Advantage |
$28,356.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,356.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,356.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,356.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,031.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,356.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,585.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,356.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,356.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,356.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,356.64
|
| Rate for Payer: NAPHCARE Commercial |
$42,534.96
|
| Rate for Payer: Quartz Medicare Advantage |
$28,356.64
|
| Rate for Payer: The Alliance Commercial |
$78,831.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,356.64
|
| Rate for Payer: United Healthcare PPO |
$44,831.01
|
| Rate for Payer: Wellcare Medicare |
$28,356.64
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
IP
|
$117,724.00
|
|
|
Service Code
|
MS-DRG 025
|
| Min. Negotiated Rate |
$42,346.78 |
| Max. Negotiated Rate |
$117,724.00 |
| Rate for Payer: Aetna Managed Medicare |
$42,346.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92,731.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71,078.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67,528.76
|
| Rate for Payer: Anthem Medicare Advantage |
$42,346.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,346.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,346.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,346.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74,963.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,346.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,112.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,346.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,346.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,346.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,346.78
|
| Rate for Payer: NAPHCARE Commercial |
$63,520.17
|
| Rate for Payer: Quartz Medicare Advantage |
$42,346.78
|
| Rate for Payer: The Alliance Commercial |
$117,724.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,346.78
|
| Rate for Payer: United Healthcare PPO |
$67,039.30
|
| Rate for Payer: Wellcare Medicare |
$42,346.78
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$65,001.00
|
|
|
Service Code
|
MS-DRG 027
|
| Min. Negotiated Rate |
$23,381.80 |
| Max. Negotiated Rate |
$65,001.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,381.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,981.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,076.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,125.54
|
| Rate for Payer: Anthem Medicare Advantage |
$23,381.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,381.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,381.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,381.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,212.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,381.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,441.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,381.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,381.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,381.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,381.80
|
| Rate for Payer: NAPHCARE Commercial |
$35,072.70
|
| Rate for Payer: Quartz Medicare Advantage |
$23,381.80
|
| Rate for Payer: The Alliance Commercial |
$65,001.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,381.80
|
| Rate for Payer: United Healthcare PPO |
$36,933.85
|
| Rate for Payer: Wellcare Medicare |
$23,381.80
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
IP
|
$162,234.00
|
|
|
Service Code
|
MS-DRG 955
|
| Min. Negotiated Rate |
$58,357.64 |
| Max. Negotiated Rate |
$162,234.00 |
| Rate for Payer: Aetna Managed Medicare |
$58,357.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127,768.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97,933.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93,043.02
|
| Rate for Payer: Anthem Medicare Advantage |
$58,357.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58,357.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58,357.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$58,357.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103,286.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$58,357.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118,758.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58,357.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58,357.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$58,357.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$58,357.64
|
| Rate for Payer: NAPHCARE Commercial |
$87,536.46
|
| Rate for Payer: Quartz Medicare Advantage |
$58,357.64
|
| Rate for Payer: The Alliance Commercial |
$162,234.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,357.64
|
| Rate for Payer: United Healthcare PPO |
$92,455.33
|
| Rate for Payer: Wellcare Medicare |
$58,357.64
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
IP
|
$151,031.00
|
|
|
Service Code
|
MS-DRG 023
|
| Min. Negotiated Rate |
$54,327.67 |
| Max. Negotiated Rate |
$151,031.00 |
| Rate for Payer: Aetna Managed Medicare |
$54,327.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118,956.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,179.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86,626.26
|
| Rate for Payer: Anthem Medicare Advantage |
$54,327.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54,327.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54,327.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54,327.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96,163.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54,327.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110,541.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54,327.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54,327.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54,327.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54,327.67
|
| Rate for Payer: NAPHCARE Commercial |
$81,491.50
|
| Rate for Payer: Quartz Medicare Advantage |
$54,327.67
|
| Rate for Payer: The Alliance Commercial |
$151,031.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54,327.67
|
| Rate for Payer: United Healthcare PPO |
$86,058.05
|
| Rate for Payer: Wellcare Medicare |
$54,327.67
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
IP
|
$101,049.00
|
|
|
Service Code
|
MS-DRG 024
|
| Min. Negotiated Rate |
$36,348.68 |
| Max. Negotiated Rate |
$101,049.00 |
| Rate for Payer: Aetna Managed Medicare |
$36,348.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79,514.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,946.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,903.62
|
| Rate for Payer: Anthem Medicare Advantage |
$36,348.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,348.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,348.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,348.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64,278.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,348.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,881.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,348.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,348.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,348.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,348.68
|
| Rate for Payer: NAPHCARE Commercial |
$54,523.02
|
| Rate for Payer: Quartz Medicare Advantage |
$36,348.68
|
| Rate for Payer: The Alliance Commercial |
$101,049.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,348.68
|
| Rate for Payer: United Healthcare PPO |
$57,517.77
|
| Rate for Payer: Wellcare Medicare |
$36,348.68
|
|
|
C-Reactive Protein
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
633716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
C-Reactive Protein
|
Professional
|
$137.00
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
633716
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
