|
DIGITAL MESH CAPS
|
Facility
OP
|
$63.00
|
|
| Hospital Charge Code |
2971103
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
DIGITAL MESH CAPS
|
Facility
IP
|
$63.00
|
|
| Hospital Charge Code |
2971103
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
DIGITAL PAD LG/XLG 10075
|
Facility
IP
|
$87.00
|
|
| Hospital Charge Code |
2969831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
DIGITAL PAD LG/XLG 10075
|
Facility
OP
|
$87.00
|
|
| Hospital Charge Code |
2969831
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
DIGIT FINGER TRAPS 9906
|
Facility
OP
|
$317.00
|
|
| Hospital Charge Code |
2964911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
DIGIT FINGER TRAPS 9906
|
Facility
IP
|
$317.00
|
|
| Hospital Charge Code |
2964911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Digoxin Level
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$134.40
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
Digoxin Level
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Aetna Managed Medicare |
$13.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.04
|
| Rate for Payer: Anthem Medicaid |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.28
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.72
|
| Rate for Payer: Dean Health Medicaid |
$13.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.28
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.28
|
| Rate for Payer: Managed Health Services Medicaid |
$14.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.92
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.72
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$145.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.28
|
| Rate for Payer: The Alliance Commercial |
$896.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.28
|
| Rate for Payer: United Healthcare PPO |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: Wellcare Medicare |
$13.28
|
| Rate for Payer: WMAP Medicaid |
$13.72
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
Digoxin Level
|
Professional
|
$224.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$212.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Aetna Managed Medicare |
$13.28
|
| Rate for Payer: Anthem Medicare Advantage |
$13.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.28
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$212.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.28
|
| Rate for Payer: Health EOS Commercial |
$203.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$212.80
|
| Rate for Payer: Quartz Beloit One Network |
$98.56
|
| Rate for Payer: Quartz Commercial |
$127.68
|
| Rate for Payer: Quartz Medicare Advantage |
$13.28
|
| Rate for Payer: The Alliance Commercial |
$52.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.28
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$58.43
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Professional
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Aetna Commercial |
$891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$135.86
|
| Rate for Payer: Anthem Medicare Advantage |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.86
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$891.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$469.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.86
|
| Rate for Payer: Health EOS Commercial |
$853.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$479.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.86
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$891.10
|
| Rate for Payer: Quartz Beloit One Network |
$412.72
|
| Rate for Payer: Quartz Commercial |
$534.66
|
| Rate for Payer: Quartz Medicare Advantage |
$135.86
|
| Rate for Payer: The Alliance Commercial |
$536.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.86
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$597.78
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Facility
IP
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$459.62 |
| Max. Negotiated Rate |
$862.96 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$562.80
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$562.80
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Facility
OP
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$3,752.00 |
| Rate for Payer: Aetna Commercial |
$844.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| Rate for Payer: Aetna Managed Medicare |
$135.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.53
|
| Rate for Payer: Anthem Medicaid |
$100.54
|
| Rate for Payer: Anthem Medicare Advantage |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.86
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$862.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.54
|
| Rate for Payer: Dean Health Medicaid |
$100.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.86
|
| Rate for Payer: Health EOS Commercial |
$834.82
|
| Rate for Payer: HFN Commercial |
$862.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.86
|
| Rate for Payer: Managed Health Services Medicaid |
$104.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.86
|
| Rate for Payer: Multiplan Commercial |
$750.40
|
| Rate for Payer: NAPHCARE Commercial |
$203.79
|
| Rate for Payer: Preferred Network Access Commercial |
$862.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.54
|
| Rate for Payer: Quartz Beloit One Network |
$459.62
|
| Rate for Payer: Quartz Commercial |
$609.70
|
| Rate for Payer: Quartz Medicare Advantage |
$135.86
|
| Rate for Payer: The Alliance Commercial |
$3,752.00
|
| Rate for Payer: United Healthcare Medicaid |
$100.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.86
|
| Rate for Payer: United Healthcare PPO |
$703.50
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: Wellcare Medicare |
$135.86
|
| Rate for Payer: WMAP Medicaid |
$100.54
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Professional
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Facility
IP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dilate Tear Duct Opening 6880150
|
Professional
|
$525.00
|
|
|
Service Code
|
CPT 68801 50
|
| Hospital Charge Code |
3798683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Medicaid |
$43.75
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
DILATION AND CURETTAGE 58120
|
Professional
|
$1,648.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
3015096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.04 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna Commercial |
$1,565.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,417.28
|
| Rate for Payer: Aetna Managed Medicare |
$219.04
|
| Rate for Payer: Anthem Medicare Advantage |
$219.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.04
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,565.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$824.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.04
|
| Rate for Payer: Health EOS Commercial |
$1,499.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.04
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,565.60
|
| Rate for Payer: Quartz Beloit One Network |
$725.12
|
| Rate for Payer: Quartz Commercial |
$939.36
|
| Rate for Payer: Quartz Medicare Advantage |
$219.04
|
| Rate for Payer: The Alliance Commercial |
$930.92
|
| Rate for Payer: United Healthcare Medicaid |
$229.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.04
|
| Rate for Payer: WEA Trust Commercial |
$906.40
|
| Rate for Payer: WPS Commercial |
$985.68
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
OP
|
$11,495.25
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$11,495.25 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$8,905.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
DILATION CATHETER & NEPHROSTOMY BALLOON 10MM X 15CM X-FORCE 995101
|
Facility
IP
|
$2,771.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5520790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.79 |
| Max. Negotiated Rate |
$2,549.32 |
| Rate for Payer: Aetna Commercial |
$2,493.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.63
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,549.32
|
| Rate for Payer: Health EOS Commercial |
$2,466.19
|
| Rate for Payer: HFN Commercial |
$2,549.32
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,549.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.79
|
| Rate for Payer: Quartz Commercial |
$1,662.60
|
| Rate for Payer: WEA Trust Commercial |
$1,524.05
|
| Rate for Payer: WPS Commercial |
$2,052.48
|
|
|
DILATION CATHETER & NEPHROSTOMY BALLOON 10MM X 15CM X-FORCE 995101
|
Facility
OP
|
$2,771.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5520790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$775.88 |
| Max. Negotiated Rate |
$2,549.32 |
| Rate for Payer: Aetna Commercial |
$2,493.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,383.06
|
| Rate for Payer: Aetna Managed Medicare |
$775.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,801.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,330.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.63
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,549.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,550.65
|
| Rate for Payer: Health EOS Commercial |
$2,466.19
|
| Rate for Payer: HFN Commercial |
$2,549.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,078.25
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,549.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.79
|
| Rate for Payer: Quartz Commercial |
$1,801.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,662.60
|
| Rate for Payer: WEA Trust Commercial |
$1,524.05
|
| Rate for Payer: WPS Commercial |
$2,052.48
|
|
|
DILATION & CURETTAGE
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
DILATION & CURETTAGE
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
DILATION & EVACUATION
|
Facility
IP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$1,060.76 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$691.80
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
DILATION & EVACUATION
|
Facility
OP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.84 |
| Max. Negotiated Rate |
$4,612.00 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Aetna Managed Medicare |
$322.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.22
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.75
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$749.45
|
| Rate for Payer: Quartz Medicare Advantage |
$691.80
|
| Rate for Payer: The Alliance Commercial |
$4,612.00
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
Dilation Of Cervical Canal 57800
|
Professional
|
$192.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
1190836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$199.94 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$44.43
|
| Rate for Payer: Anthem Medicare Advantage |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.43
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.43
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.43
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: Quartz Medicare Advantage |
$44.43
|
| Rate for Payer: The Alliance Commercial |
$188.83
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.43
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$199.94
|
|
