|
Cryoglobulin
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
3595600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Cryoglobulin Immunofixation
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
5605697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$22.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.08
|
| Rate for Payer: Anthem Medicaid |
$23.08
|
| Rate for Payer: Anthem Medicare Advantage |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.34
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$23.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.34
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.34
|
| Rate for Payer: Managed Health Services Medicaid |
$24.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.51
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.08
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$22.34
|
| Rate for Payer: The Alliance Commercial |
$89.36
|
| Rate for Payer: United Healthcare Medicaid |
$23.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: WMAP Medicaid |
$23.08
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Cryoglobulin Immunofixation
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
5605697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.86
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Cryoglobulin Immunofixation
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
5605697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
.Cryoglobulin Reflex
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
5582868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
.Cryoglobulin Reflex
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
5582868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
.Cryoglobulin Reflex
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
5582868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$14.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.32
|
| Rate for Payer: Anthem Medicaid |
$14.52
|
| Rate for Payer: Anthem Medicare Advantage |
$14.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.05
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$14.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.05
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.05
|
| Rate for Payer: Managed Health Services Medicaid |
$15.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.05
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.08
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$14.05
|
| Rate for Payer: The Alliance Commercial |
$56.20
|
| Rate for Payer: United Healthcare Medicaid |
$14.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.05
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$14.05
|
| Rate for Payer: WMAP Medicaid |
$14.52
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Cryoglobulin Screen w/ Reflex Cryoglobulin Profile
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
4075452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.40
|
| Rate for Payer: Health EOS Commercial |
$30.94
|
| Rate for Payer: HFN Commercial |
$32.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Preferred Network Access Commercial |
$32.30
|
| Rate for Payer: Quartz Beloit One Network |
$14.96
|
| Rate for Payer: Quartz Commercial |
$19.38
|
| Rate for Payer: The Alliance Commercial |
$17.00
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
Cryoglobulin Screen w/ Reflex Cryoglobulin Profile
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
4075452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$20.40
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
Cryoglobulin Screen w/ Reflex Cryoglobulin Profile
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
4075452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.74
|
| Rate for Payer: Anthem Medicaid |
$6.69
|
| Rate for Payer: Anthem Medicare Advantage |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.47
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.03
|
| Rate for Payer: Dean Health Medicaid |
$6.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.47
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.47
|
| Rate for Payer: Managed Health Services Medicaid |
$6.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.47
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.70
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.69
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$22.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6.47
|
| Rate for Payer: The Alliance Commercial |
$25.88
|
| Rate for Payer: United Healthcare Medicaid |
$6.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare PPO |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: Wellcare Medicare |
$6.47
|
| Rate for Payer: WMAP Medicaid |
$6.69
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
CRYOPROBE 2.4MM V-PROBE VARIAN CRYO-207-V
|
Facility
|
IP
|
$5,228.67
|
|
| Hospital Charge Code |
6246139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,562.05 |
| Max. Negotiated Rate |
$4,810.38 |
| Rate for Payer: Aetna Commercial |
$4,705.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,496.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.20
|
| Rate for Payer: Cash Price |
$1,568.60
|
| Rate for Payer: Cigna Commercial |
$4,810.38
|
| Rate for Payer: Health EOS Commercial |
$4,653.52
|
| Rate for Payer: HFN Commercial |
$4,810.38
|
| Rate for Payer: Multiplan Commercial |
$4,182.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,137.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.05
|
| Rate for Payer: Quartz Commercial |
$3,137.20
|
| Rate for Payer: WEA Trust Commercial |
$2,875.77
|
| Rate for Payer: WPS Commercial |
$3,872.88
|
|
|
CRYOPROBE 2.4MM V-PROBE VARIAN CRYO-207-V
|
Facility
|
OP
|
$5,228.67
|
|
| Hospital Charge Code |
6246139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,464.03 |
| Max. Negotiated Rate |
$20,914.68 |
| Rate for Payer: Aetna Commercial |
$4,705.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,496.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,464.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,398.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,614.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,509.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.20
|
| Rate for Payer: Cash Price |
$1,568.60
|
| Rate for Payer: Cigna Commercial |
$4,810.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,925.96
|
| Rate for Payer: Health EOS Commercial |
$4,653.52
|
| Rate for Payer: HFN Commercial |
$4,810.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,921.50
|
| Rate for Payer: Multiplan Commercial |
$4,182.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,137.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.05
|
| Rate for Payer: Quartz Commercial |
$3,398.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,137.20
|
| Rate for Payer: The Alliance Commercial |
$20,914.68
|
| Rate for Payer: WEA Trust Commercial |
$2,875.77
|
| Rate for Payer: WPS Commercial |
$3,872.88
|
|
|
CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE AND MONITORING)
|
Facility
|
OP
|
$36,422.04
|
|
|
Service Code
|
CPT 55873
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,795.33 |
| Max. Negotiated Rate |
$36,422.04 |
| Rate for Payer: Aetna Managed Medicare |
$9,105.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,105.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,105.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,105.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,105.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,105.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,872.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,105.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,105.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,105.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,105.51
|
| Rate for Payer: NAPHCARE Commercial |
$13,658.26
|
| Rate for Payer: Quartz Medicare Advantage |
$9,105.51
|
| Rate for Payer: The Alliance Commercial |
$36,422.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,105.51
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$9,105.51
|
|
|
CRYOTHERAPY OF SKIN 17340
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
3013673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$164.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.80
|
| Rate for Payer: Health EOS Commercial |
$157.43
|
| Rate for Payer: HFN Commercial |
$164.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.25
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.35
|
| Rate for Payer: Quartz Beloit One Network |
$76.12
|
| Rate for Payer: Quartz Commercial |
$98.61
|
| Rate for Payer: The Alliance Commercial |
$86.50
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
CRYOVEIN SAPHENOUS VEIN V010
|
Facility
|
IP
|
$41,836.00
|
|
| Hospital Charge Code |
3669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,499.64 |
| Max. Negotiated Rate |
$38,489.12 |
| Rate for Payer: Aetna Commercial |
$37,652.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,978.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,173.08
|
| Rate for Payer: Cash Price |
$12,550.80
|
| Rate for Payer: Cigna Commercial |
$38,489.12
|
| Rate for Payer: Health EOS Commercial |
$37,234.04
|
| Rate for Payer: HFN Commercial |
$38,489.12
|
| Rate for Payer: Multiplan Commercial |
$33,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,101.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,489.12
|
| Rate for Payer: Quartz Beloit One Network |
$20,499.64
|
| Rate for Payer: Quartz Commercial |
$25,101.60
|
| Rate for Payer: WEA Trust Commercial |
$23,009.80
|
| Rate for Payer: WPS Commercial |
$30,987.93
|
|
|
CRYOVEIN SAPHENOUS VEIN V010
|
Facility
|
OP
|
$41,836.00
|
|
| Hospital Charge Code |
3669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,714.08 |
| Max. Negotiated Rate |
$167,344.00 |
| Rate for Payer: Aetna Commercial |
$37,652.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,978.96
|
| Rate for Payer: Aetna Managed Medicare |
$11,714.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,193.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,918.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,081.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,173.08
|
| Rate for Payer: Cash Price |
$12,550.80
|
| Rate for Payer: Cigna Commercial |
$38,489.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,411.43
|
| Rate for Payer: Health EOS Commercial |
$37,234.04
|
| Rate for Payer: HFN Commercial |
$38,489.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,377.00
|
| Rate for Payer: Multiplan Commercial |
$33,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,101.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,489.12
|
| Rate for Payer: Quartz Beloit One Network |
$20,499.64
|
| Rate for Payer: Quartz Commercial |
$27,193.40
|
| Rate for Payer: Quartz Medicare Advantage |
$25,101.60
|
| Rate for Payer: The Alliance Commercial |
$167,344.00
|
| Rate for Payer: WEA Trust Commercial |
$23,009.80
|
| Rate for Payer: WPS Commercial |
$30,987.93
|
|
|
.Cryptococcal Ag Latex Titer
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$125.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.20
|
| Rate for Payer: Health EOS Commercial |
$120.12
|
| Rate for Payer: HFN Commercial |
$125.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.56
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.08
|
| Rate for Payer: Quartz Commercial |
$75.24
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
.Cryptococcal Ag Latex Titer
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.66
|
| Rate for Payer: Anthem Medicaid |
$9.85
|
| Rate for Payer: Anthem Medicare Advantage |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.64
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Dean Health Medicaid |
$9.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.64
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.64
|
| Rate for Payer: Managed Health Services Medicaid |
$10.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.64
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$15.96
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.85
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10.64
|
| Rate for Payer: The Alliance Commercial |
$42.56
|
| Rate for Payer: United Healthcare Medicaid |
$9.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.64
|
| Rate for Payer: United Healthcare PPO |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: Wellcare Medicare |
$10.64
|
| Rate for Payer: WMAP Medicaid |
$9.85
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
.Cryptococcal Ag Latex Titer
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.28
|
| Rate for Payer: Anthem Medicaid |
$13.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Dean Health Medicaid |
$13.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicaid |
$14.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.13
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.87
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.68
|
| Rate for Payer: United Healthcare Medicaid |
$13.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WMAP Medicaid |
$13.87
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.37
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Cryptosp Ag
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$146.28 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$95.40
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$95.40
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
Cryptosp Ag
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$146.28 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Aetna Managed Medicare |
$13.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.94
|
| Rate for Payer: Anthem Medicaid |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$146.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.98
|
| Rate for Payer: Dean Health Medicaid |
$14.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.82
|
| Rate for Payer: Health EOS Commercial |
$141.51
|
| Rate for Payer: HFN Commercial |
$146.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.82
|
| Rate for Payer: Managed Health Services Medicaid |
$14.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.82
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.73
|
| Rate for Payer: Preferred Network Access Commercial |
$146.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.28
|
| Rate for Payer: Quartz Beloit One Network |
$77.91
|
| Rate for Payer: Quartz Commercial |
$103.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.82
|
| Rate for Payer: The Alliance Commercial |
$55.28
|
| Rate for Payer: United Healthcare Medicaid |
$14.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.82
|
| Rate for Payer: United Healthcare PPO |
$119.25
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: Wellcare Medicare |
$13.82
|
| Rate for Payer: WMAP Medicaid |
$14.28
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
Cryptosp Ag
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna Commercial |
$151.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$151.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.40
|
| Rate for Payer: Health EOS Commercial |
$144.69
|
| Rate for Payer: HFN Commercial |
$151.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.78
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$151.05
|
| Rate for Payer: Quartz Beloit One Network |
$69.96
|
| Rate for Payer: Quartz Commercial |
$90.63
|
| Rate for Payer: The Alliance Commercial |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
