|
Demonstrates
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2990169
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Demonstrates
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990169
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Demonstrates
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990173
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Demonstrates
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2990177
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Demonstrates
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990177
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Demonstrate Use Home INR Mon G0248
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
6178135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$286.09 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$104.03
|
| Rate for Payer: Anthem Medicare Advantage |
$104.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.03
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.03
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.03
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$156.05
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$104.03
|
| Rate for Payer: The Alliance Commercial |
$286.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.03
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$182.05
|
|
|
DEMONSTRATE USE HOME INR MON - G0248
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
6081628
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$44.30
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
DEMONSTRATE USE HOME INR MON - G0248
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
6081628
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$35.44 |
| Max. Negotiated Rate |
$560.44 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Aetna Managed Medicare |
$140.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.44
|
| Rate for Payer: Anthem Medicare Advantage |
$140.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.11
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.11
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.11
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: NAPHCARE Commercial |
$210.16
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: Quartz Medicare Advantage |
$140.11
|
| Rate for Payer: The Alliance Commercial |
$560.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.11
|
| Rate for Payer: United Healthcare PPO |
$55.38
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: Wellcare Medicare |
$140.11
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
Denali Vena Cava Filter-Femoral
|
Facility
|
OP
|
$6,585.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
4528620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,917.55 |
| Max. Negotiated Rate |
$6,300.53 |
| Rate for Payer: Aetna Commercial |
$6,163.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,889.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,917.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,451.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,424.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,287.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,629.65
|
| Rate for Payer: Cash Price |
$1,975.50
|
| Rate for Payer: Cigna Commercial |
$6,300.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,832.47
|
| Rate for Payer: Health EOS Commercial |
$6,095.08
|
| Rate for Payer: HFN Commercial |
$6,300.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,136.30
|
| Rate for Payer: Multiplan Commercial |
$5,478.72
|
| Rate for Payer: NAPHCARE Commercial |
$4,109.04
|
| Rate for Payer: Preferred Network Access Commercial |
$6,300.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,355.72
|
| Rate for Payer: Quartz Commercial |
$4,451.46
|
| Rate for Payer: Quartz Medicare Advantage |
$4,109.04
|
| Rate for Payer: The Alliance Commercial |
$3,424.20
|
| Rate for Payer: WEA Trust Commercial |
$3,766.62
|
| Rate for Payer: WPS Commercial |
$5,072.43
|
|
|
Denali Vena Cava Filter-Femoral
|
Facility
|
IP
|
$6,585.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
4528620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,355.72 |
| Max. Negotiated Rate |
$6,300.53 |
| Rate for Payer: Aetna Commercial |
$6,163.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,889.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,629.65
|
| Rate for Payer: Cash Price |
$1,975.50
|
| Rate for Payer: Cigna Commercial |
$6,300.53
|
| Rate for Payer: Health EOS Commercial |
$6,095.08
|
| Rate for Payer: HFN Commercial |
$6,300.53
|
| Rate for Payer: Multiplan Commercial |
$5,478.72
|
| Rate for Payer: Preferred Network Access Commercial |
$6,300.53
|
| Rate for Payer: Quartz Beloit One Network |
$3,355.72
|
| Rate for Payer: Quartz Commercial |
$4,109.04
|
| Rate for Payer: WEA Trust Commercial |
$3,766.62
|
| Rate for Payer: WPS Commercial |
$5,072.43
|
|
|
Denali Vena Cava Filter-Jugular
|
Facility
|
IP
|
$6,340.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
4528619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.86 |
| Max. Negotiated Rate |
$6,066.11 |
| Rate for Payer: Aetna Commercial |
$5,934.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,670.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,494.61
|
| Rate for Payer: Cash Price |
$1,902.00
|
| Rate for Payer: Cigna Commercial |
$6,066.11
|
| Rate for Payer: Health EOS Commercial |
$5,868.30
|
| Rate for Payer: HFN Commercial |
$6,066.11
|
| Rate for Payer: Multiplan Commercial |
$5,274.88
|
| Rate for Payer: Preferred Network Access Commercial |
$6,066.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,230.86
|
| Rate for Payer: Quartz Commercial |
$3,956.16
|
| Rate for Payer: WEA Trust Commercial |
$3,626.48
|
| Rate for Payer: WPS Commercial |
$4,883.70
|
|
|
Denali Vena Cava Filter-Jugular
|
Facility
|
OP
|
$6,340.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
4528619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,846.21 |
| Max. Negotiated Rate |
$6,066.11 |
| Rate for Payer: Aetna Commercial |
$5,934.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,670.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,846.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,285.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,296.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,164.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,494.61
|
| Rate for Payer: Cash Price |
$1,902.00
|
| Rate for Payer: Cigna Commercial |
$6,066.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,689.88
|
| Rate for Payer: Health EOS Commercial |
$5,868.30
|
| Rate for Payer: HFN Commercial |
$6,066.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,945.20
|
| Rate for Payer: Multiplan Commercial |
$5,274.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,956.16
|
| Rate for Payer: Preferred Network Access Commercial |
$6,066.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,230.86
|
| Rate for Payer: Quartz Commercial |
$4,285.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,956.16
|
| Rate for Payer: The Alliance Commercial |
$3,296.80
|
| Rate for Payer: WEA Trust Commercial |
$3,626.48
|
| Rate for Payer: WPS Commercial |
$4,883.70
|
|
|
Dengue Fever Antibodies (IgG, IgM)
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Dengue Fever Antibodies (IgG, IgM)
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
Dengue Fever Antibodies (IgG, IgM)
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
Dengue Fever Antibodies IgG, IgM
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dengue Fever Antibodies IgG, IgM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$181.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$174.14
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$84.20
|
| Rate for Payer: Quartz Commercial |
$109.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Dengue Fever Antibodies IgG, IgM
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4392804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
Dengue Virus RNA, Real-Time PCR
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Dengue Virus RNA, Real-Time PCR
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Dengue Virus RNA, Real-Time PCR
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
DENTAL AND ORAL DIAGNOSES AND INJURIES
|
Facility
|
OP
|
$81.24
|
|
|
Service Code
|
EAPG 00563
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$81.24 |
| Rate for Payer: Anthem Medicaid |
$78.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$78.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.11
|
| Rate for Payer: Dean Health Medicaid |
$78.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$78.11
|
| Rate for Payer: Managed Health Services Medicaid |
$81.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$78.11
|
| Rate for Payer: United Healthcare Medicaid |
$78.11
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$26,281.84
|
|
|
Service Code
|
MSDRG 158
|
| Min. Negotiated Rate |
$7,474.22 |
| Max. Negotiated Rate |
$26,281.84 |
| Rate for Payer: Aetna Managed Medicare |
$7,474.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,851.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,215.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,455.92
|
| Rate for Payer: Anthem Medicare Advantage |
$7,474.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,474.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,474.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,474.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,047.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,474.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,032.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,474.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,474.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,474.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,474.22
|
| Rate for Payer: NAPHCARE Commercial |
$11,211.33
|
| Rate for Payer: Quartz Medicare Advantage |
$7,474.22
|
| Rate for Payer: The Alliance Commercial |
$26,281.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,474.22
|
| Rate for Payer: United Healthcare PPO |
$14,817.26
|
| Rate for Payer: Wellcare Medicare |
$7,474.22
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$47,531.12
|
|
|
Service Code
|
MSDRG 157
|
| Min. Negotiated Rate |
$13,654.38 |
| Max. Negotiated Rate |
$47,531.12 |
| Rate for Payer: Aetna Managed Medicare |
$13,654.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,459.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,712.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,278.44
|
| Rate for Payer: Anthem Medicare Advantage |
$13,654.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,654.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,654.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,654.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,281.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,654.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,617.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,654.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,654.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,654.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,654.38
|
| Rate for Payer: NAPHCARE Commercial |
$20,481.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13,654.38
|
| Rate for Payer: The Alliance Commercial |
$47,531.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,654.38
|
| Rate for Payer: United Healthcare PPO |
$26,950.53
|
| Rate for Payer: Wellcare Medicare |
$13,654.38
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,001.84
|
|
|
Service Code
|
MSDRG 159
|
| Min. Negotiated Rate |
$5,932.61 |
| Max. Negotiated Rate |
$19,001.84 |
| Rate for Payer: Aetna Managed Medicare |
$5,932.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,458.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,849.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,257.44
|
| Rate for Payer: Anthem Medicare Advantage |
$5,932.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,932.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,932.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,932.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,496.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,932.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,693.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,932.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,932.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,932.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,932.61
|
| Rate for Payer: NAPHCARE Commercial |
$8,898.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5,932.61
|
| Rate for Payer: The Alliance Commercial |
$19,001.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,932.61
|
| Rate for Payer: United Healthcare PPO |
$10,660.22
|
| Rate for Payer: Wellcare Medicare |
$5,932.61
|
|
