|
Creatinine, Urine
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
5474696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Creatinine, Urine, PDI
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
979892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| 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 |
$66.78
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| 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 |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| 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 |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Creatinine, Urine, PDI
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
979892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Creatinine, Urine, PDI
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
979892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| 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 |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| 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 |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| 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 |
$69.30
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
OP
|
$20,943.68
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
|
|
Creat-Mercury
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
5364706
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| 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 |
$19.08
|
| 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 |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| 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 |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| 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 |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
Creat-Mercury
|
Facility
IP
|
$36.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
5364706
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
Creat-Mercury
|
Professional
|
$36.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
5364706
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| 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 |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$32.76
|
| 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 |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.20
|
| Rate for Payer: Quartz Beloit One Network |
$15.84
|
| Rate for Payer: Quartz Commercial |
$20.52
|
| 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 |
$19.80
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
CREST PADS
|
Facility
IP
|
$162.00
|
|
| Hospital Charge Code |
2971123
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
CREST PADS
|
Facility
OP
|
$162.00
|
|
| Hospital Charge Code |
2971123
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$45.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.66
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$97.20
|
| Rate for Payer: The Alliance Commercial |
$648.00
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
CRICOPHARYNGEAL MYOTOMY
|
Facility
OP
|
$6,052.00
|
|
| Hospital Charge Code |
2959955
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,694.56 |
| Max. Negotiated Rate |
$24,208.00 |
| Rate for Payer: Aetna Commercial |
$5,446.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,204.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,694.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,933.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,026.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,904.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,207.56
|
| Rate for Payer: Cash Price |
$1,815.60
|
| Rate for Payer: Cigna Commercial |
$5,567.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,386.70
|
| Rate for Payer: Health EOS Commercial |
$5,386.28
|
| Rate for Payer: HFN Commercial |
$5,567.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,539.00
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,631.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,567.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,965.48
|
| Rate for Payer: Quartz Commercial |
$3,933.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,631.20
|
| Rate for Payer: The Alliance Commercial |
$24,208.00
|
| Rate for Payer: WEA Trust Commercial |
$3,328.60
|
| Rate for Payer: WPS Commercial |
$4,482.72
|
|
|
CRICOPHARYNGEAL MYOTOMY
|
Facility
IP
|
$6,052.00
|
|
| Hospital Charge Code |
2959955
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,965.48 |
| Max. Negotiated Rate |
$5,567.84 |
| Rate for Payer: Aetna Commercial |
$5,446.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,207.56
|
| Rate for Payer: Cash Price |
$1,815.60
|
| Rate for Payer: Cigna Commercial |
$5,567.84
|
| Rate for Payer: Health EOS Commercial |
$5,386.28
|
| Rate for Payer: HFN Commercial |
$5,567.84
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,631.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,567.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,965.48
|
| Rate for Payer: Quartz Commercial |
$3,631.20
|
| Rate for Payer: WEA Trust Commercial |
$3,328.60
|
| Rate for Payer: WPS Commercial |
$4,482.72
|
|
|
Critical Care 30-74 min - 99291
|
Facility
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
5516691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$877.08 |
| Max. Negotiated Rate |
$5,245.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$877.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,245.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,020.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,819.00
|
| Rate for Payer: Anthem Medicare Advantage |
$877.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$877.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$877.08
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$877.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$877.08
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,262.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$877.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$877.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$877.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$877.08
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$877.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$877.08
|
| Rate for Payer: United Healthcare PPO |
$3,078.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: Wellcare Medicare |
$877.08
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
Critical Care 30-74 min - 99291
|
Facility
IP
|
$4,460.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
5516691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
CRMP-5 IgG
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
CRMP-5 IgG
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
CRMP-5 IgG
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Crohn's Interp & Report
|
Professional
|
$20.00
|
|
| Hospital Charge Code |
2794802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$8.80
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$10.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Crohn's Interp & Report
|
Facility
IP
|
$20.00
|
|
| Hospital Charge Code |
2794802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Crohn's Interp & Report
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
2794802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.60
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$18.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.19
|
| Rate for Payer: Health EOS Commercial |
$17.80
|
| Rate for Payer: HFN Commercial |
$18.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18.40
|
| Rate for Payer: Quartz Beloit One Network |
$9.80
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: United Healthcare PPO |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$11.00
|
| Rate for Payer: WPS Commercial |
$14.81
|
|
|
Crohn's Prognostic DNASE
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4596750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Crohn's Prognostic DNASE
|
Facility
OP
|
$196.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4596750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: United Healthcare PPO |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Crohn's Prognostic DNASE
|
Professional
|
$196.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4596750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$494.03 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$112.28
|
| Rate for Payer: Anthem Commercial |
$22.51
|
| Rate for Payer: Anthem Medicare Advantage |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.28
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$186.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.28
|
| Rate for Payer: Health EOS Commercial |
$178.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.28
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$186.20
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$111.72
|
| Rate for Payer: Quartz Medicare Advantage |
$112.28
|
| Rate for Payer: The Alliance Commercial |
$443.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.28
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$494.03
|
|
|
Crohn's Prognostic ELISA
|
Facility
IP
|
$196.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4596748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Crohn's Prognostic ELISA
|
Professional
|
$196.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4596748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$186.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$178.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$186.20
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$111.72
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
