|
Different Drug Addíl IV Push 96375 - Admin Each Add'l IV Push Charge
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
3023768
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$187.80 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Different Drug Addíl IV Push 96375 - Admin Each Add'l IV Push Charge
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
3023768
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Diffusion Capacity - Pulmonary Function Test Charge
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
3006997
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare PPO |
$506.25
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
Diffusion Capacity - Pulmonary Function Test Charge
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
3006997
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$32,178.00
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$11,574.97 |
| Max. Negotiated Rate |
$32,178.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,574.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,574.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,574.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,574.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,574.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,574.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,366.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,574.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,574.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,574.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,574.97
|
| Rate for Payer: NAPHCARE Commercial |
$17,362.46
|
| Rate for Payer: Quartz Medicare Advantage |
$11,574.97
|
| Rate for Payer: The Alliance Commercial |
$32,178.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,574.97
|
| Rate for Payer: United Healthcare PPO |
$18,191.39
|
| Rate for Payer: Wellcare Medicare |
$11,574.97
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$56,124.00
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$20,188.62 |
| Max. Negotiated Rate |
$56,124.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,188.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,058.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,770.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,083.80
|
| Rate for Payer: Anthem Medicare Advantage |
$20,188.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,188.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,188.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,188.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,615.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,188.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,930.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,188.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,188.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,188.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,188.62
|
| Rate for Payer: NAPHCARE Commercial |
$30,282.93
|
| Rate for Payer: Quartz Medicare Advantage |
$20,188.62
|
| Rate for Payer: The Alliance Commercial |
$56,124.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,188.62
|
| Rate for Payer: United Healthcare PPO |
$31,864.92
|
| Rate for Payer: Wellcare Medicare |
$20,188.62
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$24,019.00
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$8,639.99 |
| Max. Negotiated Rate |
$24,019.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,639.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,639.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,639.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,639.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,639.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,639.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,382.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,639.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,639.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,639.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,639.99
|
| Rate for Payer: NAPHCARE Commercial |
$12,959.98
|
| Rate for Payer: Quartz Medicare Advantage |
$8,639.99
|
| Rate for Payer: The Alliance Commercial |
$24,019.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,639.99
|
| Rate for Payer: United Healthcare PPO |
$13,532.34
|
| Rate for Payer: Wellcare Medicare |
$8,639.99
|
|
|
DIGITAL BLOCK - SET-UP CHARGE
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
4519590
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$64.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$137.40
|
| Rate for Payer: The Alliance Commercial |
$916.00
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
DIGITAL BLOCK - SET-UP CHARGE
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
4519590
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
DIGITAL CAP RIBBED KNIT L/XL 10206
|
Facility
|
IP
|
$101.00
|
|
| Hospital Charge Code |
2971213
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
DIGITAL CAP RIBBED KNIT L/XL 10206
|
Facility
|
OP
|
$101.00
|
|
| Hospital Charge Code |
2971213
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
DIGITAL CAP RIBBED KNIT S/M 10205
|
Facility
|
IP
|
$110.00
|
|
| Hospital Charge Code |
2971266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
DIGITAL CAP RIBBED KNIT S/M 10205
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
2971266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$66.00
|
| Rate for Payer: The Alliance Commercial |
$440.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| 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
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| 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
|
|
|
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
|
|
|
Digoxin Level
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$212.80 |
| Rate for Payer: Aetna Commercial |
$212.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| 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 |
$134.40
|
| Rate for Payer: Health EOS Commercial |
$203.84
|
| Rate for Payer: HFN Commercial |
$212.80
|
| 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: 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: The Alliance Commercial |
$112.00
|
| 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 |
$206.08 |
| 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 DHI/DHP/ASO |
$125.35
|
| 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 |
$53.12
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| 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 |
$862.96 |
| 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 DHI/DHP/ASO |
$524.90
|
| 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 |
$543.44
|
| 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
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$412.72 |
| Max. Negotiated Rate |
$891.10 |
| Rate for Payer: Aetna Commercial |
$891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$806.68
|
| 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 |
$562.80
|
| Rate for Payer: Health EOS Commercial |
$853.58
|
| Rate for Payer: HFN Commercial |
$891.10
|
| 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: 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: The Alliance Commercial |
$469.00
|
| Rate for Payer: WEA Trust Commercial |
$515.90
|
| Rate for Payer: WPS Commercial |
$694.78
|
|
