|
Cyclosporine Level
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$74.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
Cyclosporine Level to Mayo
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$270.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$259.31
|
| Rate for Payer: HFN Commercial |
$270.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$270.71
|
| Rate for Payer: Quartz Beloit One Network |
$125.38
|
| Rate for Payer: Quartz Commercial |
$162.43
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$74.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
Cyclosporine Level to Mayo
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.16
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$75.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: United Healthcare PPO |
$213.72
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: Wellcare Medicare |
$18.77
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Cyclosporine Level to Mayo
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
CYLINDER TANK HOLDER PORTABLE
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2972315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$96.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.74
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$207.79
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$207.79
|
| Rate for Payer: The Alliance Commercial |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
CYLINDER TANK HOLDER PORTABLE
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2972315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
Cystatin C w/ eGFR
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Cystatin C w/ eGFR
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.97
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$77.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: Wellcare Medicare |
$19.26
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Cystatin C w/ eGFR
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$175.86 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.26
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.26
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.26
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$28.89
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$19.26
|
| Rate for Payer: The Alliance Commercial |
$76.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.26
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$84.75
|
|
|
CYSTECTOMY
|
Facility
|
IP
|
$7,956.00
|
|
| Hospital Charge Code |
2959975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,054.38 |
| Max. Negotiated Rate |
$7,612.30 |
| Rate for Payer: Aetna Commercial |
$7,446.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,115.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,385.35
|
| Rate for Payer: Cash Price |
$2,386.80
|
| Rate for Payer: Cigna Commercial |
$7,612.30
|
| Rate for Payer: Health EOS Commercial |
$7,364.07
|
| Rate for Payer: HFN Commercial |
$7,612.30
|
| Rate for Payer: Multiplan Commercial |
$6,619.39
|
| Rate for Payer: Preferred Network Access Commercial |
$7,612.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,054.38
|
| Rate for Payer: Quartz Commercial |
$4,964.54
|
| Rate for Payer: WEA Trust Commercial |
$4,550.83
|
| Rate for Payer: WPS Commercial |
$6,128.51
|
|
|
CYSTECTOMY
|
Facility
|
OP
|
$7,956.00
|
|
| Hospital Charge Code |
2959975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,316.79 |
| Max. Negotiated Rate |
$7,612.30 |
| Rate for Payer: Aetna Commercial |
$7,446.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,115.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,316.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,378.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,137.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,971.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,385.35
|
| Rate for Payer: Cash Price |
$2,386.80
|
| Rate for Payer: Cigna Commercial |
$7,612.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,630.39
|
| Rate for Payer: Health EOS Commercial |
$7,364.07
|
| Rate for Payer: HFN Commercial |
$7,612.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,205.68
|
| Rate for Payer: Multiplan Commercial |
$6,619.39
|
| Rate for Payer: NAPHCARE Commercial |
$4,964.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,612.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,054.38
|
| Rate for Payer: Quartz Commercial |
$5,378.26
|
| Rate for Payer: Quartz Medicare Advantage |
$4,964.54
|
| Rate for Payer: The Alliance Commercial |
$4,137.12
|
| Rate for Payer: WEA Trust Commercial |
$4,550.83
|
| Rate for Payer: WPS Commercial |
$6,128.51
|
|
|
Cysticercus Antibody
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$59.53
|
|
|
Cysticercus Antibody
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
Cysticercus Antibody
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$54.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: United Healthcare PPO |
$370.50
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$54.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: United Healthcare PPO |
$103.74
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$131.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$125.87
|
| Rate for Payer: HFN Commercial |
$131.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$131.40
|
| Rate for Payer: Quartz Beloit One Network |
$60.86
|
| Rate for Payer: Quartz Commercial |
$78.84
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$59.53
|
|
|
Cystic Fibrosis Interpretation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Cystic Fibrosis Interpretation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Cystic Fibrosis Interpretation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Cystic Fibrosis Mutation DNA Analysis
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
977920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Cystic Fibrosis Mutation DNA Analysis
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
977920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$2,315.46 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$578.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,170.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,013.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.91
|
| Rate for Payer: Anthem Medicare Advantage |
$578.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$578.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$578.86
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$578.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$578.86
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,153.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$578.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$578.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$578.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$578.86
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$868.30
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$578.86
|
| Rate for Payer: The Alliance Commercial |
$2,315.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.86
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$578.86
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Cystic Fibrosis Mutation DNA Analysis
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
977920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$2,547.00 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$578.86
|
| Rate for Payer: Anthem Medicare Advantage |
$578.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$578.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$578.86
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.86
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,043.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,043.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$578.86
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$868.30
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$578.86
|
| Rate for Payer: The Alliance Commercial |
$2,286.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.86
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$2,547.00
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
IP
|
$15,519.91
|
|
|
Service Code
|
APR-DRG 1312
|
| Min. Negotiated Rate |
$13,785.75 |
| Max. Negotiated Rate |
$15,519.91 |
| Rate for Payer: Anthem Medicaid |
$14,861.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,861.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,861.17
|
| Rate for Payer: Dean Health Medicaid |
$14,861.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,785.75
|
| Rate for Payer: Managed Health Services Medicaid |
$15,519.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,861.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,861.17
|
| Rate for Payer: United Healthcare Medicaid |
$14,861.17
|
|
|
CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
OP
|
$62.19
|
|
|
Service Code
|
EAPG 00570
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Anthem Medicaid |
$59.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$59.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health Medicaid |
$59.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$59.80
|
| Rate for Payer: Managed Health Services Medicaid |
$62.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$59.80
|
| Rate for Payer: United Healthcare Medicaid |
$59.80
|
|
