|
EAPG 91: LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
OP
|
$1,906.27
|
|
|
Service Code
|
EAPG 00091
|
| Min. Negotiated Rate |
$1,660.32 |
| Max. Negotiated Rate |
$1,906.27 |
| Rate for Payer: Anthem Medicaid |
$1,660.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,906.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,660.32
|
| Rate for Payer: Dean Health Medicaid |
$1,660.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,660.32
|
| Rate for Payer: Managed Health Services Medicaid |
$1,726.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,906.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,660.32
|
| Rate for Payer: United Healthcare Medicaid |
$1,660.32
|
| Rate for Payer: WMAP Medicaid |
$1,660.32
|
|
|
EAPG 92: RESUSCITATION
|
Facility
OP
|
$533.81
|
|
|
Service Code
|
EAPG 00092
|
| Min. Negotiated Rate |
$292.05 |
| Max. Negotiated Rate |
$533.81 |
| Rate for Payer: Anthem Medicaid |
$292.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$533.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.05
|
| Rate for Payer: Dean Health Medicaid |
$292.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$292.05
|
| Rate for Payer: Managed Health Services Medicaid |
$303.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$292.05
|
| Rate for Payer: United Healthcare Medicaid |
$292.05
|
| Rate for Payer: WMAP Medicaid |
$292.05
|
|
|
EAPG 93: CARDIOVERSION
|
Facility
OP
|
$481.51
|
|
|
Service Code
|
EAPG 00093
|
| Min. Negotiated Rate |
$257.48 |
| Max. Negotiated Rate |
$481.51 |
| Rate for Payer: Anthem Medicaid |
$257.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$481.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.48
|
| Rate for Payer: Dean Health Medicaid |
$257.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$257.48
|
| Rate for Payer: Managed Health Services Medicaid |
$267.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$481.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$257.48
|
| Rate for Payer: United Healthcare Medicaid |
$257.48
|
| Rate for Payer: WMAP Medicaid |
$257.48
|
|
|
EAPG 94: CARDIAC REHABILITATION
|
Facility
OP
|
$380.87
|
|
|
Service Code
|
EAPG 00094
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$380.87 |
| Rate for Payer: Anthem Medicaid |
$64.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$380.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.84
|
| Rate for Payer: Dean Health Medicaid |
$64.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.84
|
| Rate for Payer: Managed Health Services Medicaid |
$67.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.84
|
| Rate for Payer: United Healthcare Medicaid |
$64.84
|
| Rate for Payer: WMAP Medicaid |
$64.84
|
|
|
EAPG 96: CARDIAC ELECTROPHYSIOLOGIC PROCEDURES INCLUDING PACING AND RECORDING
|
Facility
OP
|
$4,127.33
|
|
|
Service Code
|
EAPG 00096
|
| Min. Negotiated Rate |
$2,647.19 |
| Max. Negotiated Rate |
$4,127.33 |
| Rate for Payer: Anthem Medicaid |
$2,647.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,127.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,647.19
|
| Rate for Payer: Dean Health Medicaid |
$2,647.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,647.19
|
| Rate for Payer: Managed Health Services Medicaid |
$2,753.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,127.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,647.19
|
| Rate for Payer: United Healthcare Medicaid |
$2,647.19
|
| Rate for Payer: WMAP Medicaid |
$2,647.19
|
|
|
EAPG 97: AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT
|
Facility
OP
|
$18,236.47
|
|
|
Service Code
|
EAPG 00097
|
| Min. Negotiated Rate |
$9,209.36 |
| Max. Negotiated Rate |
$18,236.47 |
| Rate for Payer: Anthem Medicaid |
$9,209.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,236.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,209.36
|
| Rate for Payer: Dean Health Medicaid |
$9,209.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,209.36
|
| Rate for Payer: Managed Health Services Medicaid |
$9,577.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,236.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,209.36
|
| Rate for Payer: United Healthcare Medicaid |
$9,209.36
|
| Rate for Payer: WMAP Medicaid |
$9,209.36
|
|
|
EAPG 99: LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES
|
Facility
OP
|
$6,795.49
|
|
|
Service Code
|
EAPG 00099
|
| Min. Negotiated Rate |
$3,407.35 |
| Max. Negotiated Rate |
$6,795.49 |
| Rate for Payer: Anthem Medicaid |
$3,407.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,795.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,407.35
|
| Rate for Payer: Dean Health Medicaid |
$3,407.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,407.35
|
| Rate for Payer: Managed Health Services Medicaid |
$3,543.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,795.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,407.35
|
| Rate for Payer: United Healthcare Medicaid |
$3,407.35
|
| Rate for Payer: WMAP Medicaid |
$3,407.35
|
|
|
EAPG 9: LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
OP
|
$509.30
|
|
|
Service Code
|
EAPG 00009
|
| Min. Negotiated Rate |
$174.70 |
| Max. Negotiated Rate |
$509.30 |
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$509.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.70
|
| Rate for Payer: Dean Health Medicaid |
$174.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$174.70
|
| Rate for Payer: Managed Health Services Medicaid |
$181.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$509.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$174.70
|
| Rate for Payer: United Healthcare Medicaid |
$174.70
|
| Rate for Payer: WMAP Medicaid |
$174.70
|
|
|
EAR AND THROAT EXAMINATION 92502
|
Professional
|
$773.00
|
|
|
Service Code
|
CPT 92502
|
| Hospital Charge Code |
3015328
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.87 |
| Max. Negotiated Rate |
$734.35 |
| Rate for Payer: Aetna Commercial |
$734.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.78
|
| Rate for Payer: Aetna Managed Medicare |
$90.87
|
| Rate for Payer: Anthem Medicare Advantage |
$90.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.87
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cash Price |
$231.90
|
| Rate for Payer: Cigna Commercial |
$734.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.87
|
| Rate for Payer: Health EOS Commercial |
$703.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$319.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.87
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$734.35
|
| Rate for Payer: Quartz Beloit One Network |
$340.12
|
| Rate for Payer: Quartz Commercial |
$440.61
|
| Rate for Payer: Quartz Medicare Advantage |
$90.87
|
| Rate for Payer: The Alliance Commercial |
$227.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.87
|
| Rate for Payer: WEA Trust Commercial |
$425.15
|
| Rate for Payer: WPS Commercial |
$363.48
|
|
|
Ear Culture
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Ear Culture
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Ear Culture
|
Professional
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$37.93
|
|
|
EAR DRESSING GLASSCOCK ADULT S-1000
|
Facility
IP
|
$313.00
|
|
| Hospital Charge Code |
3204818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
EAR DRESSING GLASSCOCK ADULT S-1000
|
Facility
OP
|
$313.00
|
|
| Hospital Charge Code |
3204818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.64 |
| Max. Negotiated Rate |
$1,252.00 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$203.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$187.80
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
EAR EXAM WITH ANESTHESIA
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
EAR EXAM WITH ANESTHESIA
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Early Sjogren's Syndrome Profile
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$199.20
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Early Sjogren's Syndrome Profile
|
Professional
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna Commercial |
$315.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$302.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Preferred Network Access Commercial |
$315.40
|
| Rate for Payer: Quartz Beloit One Network |
$146.08
|
| Rate for Payer: Quartz Commercial |
$189.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
|
Early Sjogren's Syndrome Profile
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5455288
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Ear Mold/Insert
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Ear Mold/Insert
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$67.20
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: United Healthcare PPO |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Ear Mold/Insert
|
Professional
|
$112.00
|
|
|
Service Code
|
HCPCS V5264
|
| Hospital Charge Code |
3243645
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna Commercial |
$106.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.20
|
| Rate for Payer: Health EOS Commercial |
$101.92
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.40
|
| Rate for Payer: Quartz Beloit One Network |
$49.28
|
| Rate for Payer: Quartz Commercial |
$63.84
|
| Rate for Payer: The Alliance Commercial |
$56.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Ear Mold/Insert, Disp
|
Professional
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.40
|
| Rate for Payer: Health EOS Commercial |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Preferred Network Access Commercial |
$18.05
|
| Rate for Payer: Quartz Beloit One Network |
$8.36
|
| Rate for Payer: Quartz Commercial |
$10.83
|
| Rate for Payer: The Alliance Commercial |
$9.50
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Ear Mold/Insert, Disp
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Ear Mold/Insert, Disp
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
HCPCS V5265
|
| Hospital Charge Code |
3243651
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.63
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: United Healthcare PPO |
$14.25
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
