|
East Equine IgM
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
East Equine IgM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Eastern Equine IgG
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Eastern Equine IgG
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Eastern Equine IgG
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$83.98 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Eastern Equine IgM
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Eastern Equine IgM
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$83.98 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Eastern Equine IgM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
|
OP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.03 |
| Max. Negotiated Rate |
$5,911.11 |
| Rate for Payer: Aetna Commercial |
$5,782.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,525.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,799.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,176.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,212.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,084.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,405.31
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,911.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,595.60
|
| Rate for Payer: Health EOS Commercial |
$5,718.36
|
| Rate for Payer: HFN Commercial |
$5,911.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,818.84
|
| Rate for Payer: Multiplan Commercial |
$5,140.10
|
| Rate for Payer: NAPHCARE Commercial |
$3,855.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,911.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,148.31
|
| Rate for Payer: Quartz Commercial |
$4,176.33
|
| Rate for Payer: Quartz Medicare Advantage |
$3,855.07
|
| Rate for Payer: The Alliance Commercial |
$3,212.56
|
| Rate for Payer: WEA Trust Commercial |
$3,533.82
|
| Rate for Payer: WPS Commercial |
$4,758.91
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
|
IP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,148.31 |
| Max. Negotiated Rate |
$5,911.11 |
| Rate for Payer: Aetna Commercial |
$5,782.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,525.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,405.31
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,911.11
|
| Rate for Payer: Health EOS Commercial |
$5,718.36
|
| Rate for Payer: HFN Commercial |
$5,911.11
|
| Rate for Payer: Multiplan Commercial |
$5,140.10
|
| Rate for Payer: Preferred Network Access Commercial |
$5,911.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,148.31
|
| Rate for Payer: Quartz Commercial |
$3,855.07
|
| Rate for Payer: WEA Trust Commercial |
$3,533.82
|
| Rate for Payer: WPS Commercial |
$4,758.91
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 7592
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$29,724.57
|
|
|
Service Code
|
APR-DRG 7594
|
| Min. Negotiated Rate |
$26,403.22 |
| Max. Negotiated Rate |
$29,724.57 |
| Rate for Payer: Anthem Medicaid |
$28,462.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,462.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,462.91
|
| Rate for Payer: Dean Health Medicaid |
$28,462.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,403.22
|
| Rate for Payer: Managed Health Services Medicaid |
$29,724.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,462.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,462.91
|
| Rate for Payer: United Healthcare Medicaid |
$28,462.91
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$9,382.09
|
|
|
Service Code
|
APR-DRG 7591
|
| Min. Negotiated Rate |
$8,333.76 |
| Max. Negotiated Rate |
$9,382.09 |
| Rate for Payer: Anthem Medicaid |
$8,983.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,983.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,983.87
|
| Rate for Payer: Dean Health Medicaid |
$8,983.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,333.76
|
| Rate for Payer: Managed Health Services Medicaid |
$9,382.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,983.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,983.87
|
| Rate for Payer: United Healthcare Medicaid |
$8,983.87
|
|
|
EATING DISORDERS
|
Facility
|
OP
|
$86.48
|
|
|
Service Code
|
EAPG 00830
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Anthem Medicaid |
$83.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$83.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.15
|
| Rate for Payer: Dean Health Medicaid |
$83.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.15
|
| Rate for Payer: Managed Health Services Medicaid |
$86.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.15
|
| Rate for Payer: United Healthcare Medicaid |
$83.15
|
|
|
EATING DISORDERS
|
Facility
|
IP
|
$17,711.99
|
|
|
Service Code
|
APR-DRG 7593
|
| Min. Negotiated Rate |
$15,732.89 |
| Max. Negotiated Rate |
$17,711.99 |
| Rate for Payer: Anthem Medicaid |
$16,960.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,960.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,960.20
|
| Rate for Payer: Dean Health Medicaid |
$16,960.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,732.89
|
| Rate for Payer: Managed Health Services Medicaid |
$17,711.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,960.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,960.20
|
| Rate for Payer: United Healthcare Medicaid |
$16,960.20
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.54 |
| Max. Negotiated Rate |
$4,688.32 |
| Rate for Payer: Aetna Commercial |
$4,586.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,382.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,426.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,312.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,548.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,446.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,700.88
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,688.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$4,535.44
|
| Rate for Payer: HFN Commercial |
$4,688.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,822.00
|
| Rate for Payer: Multiplan Commercial |
$4,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,057.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,688.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,497.04
|
| Rate for Payer: Quartz Commercial |
$3,312.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,057.60
|
| Rate for Payer: The Alliance Commercial |
$234.54
|
| Rate for Payer: WEA Trust Commercial |
$2,802.80
|
| Rate for Payer: WPS Commercial |
$3,774.47
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,497.04 |
| Max. Negotiated Rate |
$4,688.32 |
| Rate for Payer: Aetna Commercial |
$4,586.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,382.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,700.88
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,688.32
|
| Rate for Payer: Health EOS Commercial |
$4,535.44
|
| Rate for Payer: HFN Commercial |
$4,688.32
|
| Rate for Payer: Multiplan Commercial |
$4,076.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,688.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,497.04
|
| Rate for Payer: Quartz Commercial |
$3,057.60
|
| Rate for Payer: WEA Trust Commercial |
$2,802.80
|
| Rate for Payer: WPS Commercial |
$3,774.47
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
|
IP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,927.49 |
| Max. Negotiated Rate |
$7,374.06 |
| Rate for Payer: Aetna Commercial |
$7,213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,893.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,248.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,374.06
|
| Rate for Payer: Health EOS Commercial |
$7,133.60
|
| Rate for Payer: HFN Commercial |
$7,374.06
|
| Rate for Payer: Multiplan Commercial |
$6,412.22
|
| Rate for Payer: Preferred Network Access Commercial |
$7,374.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,927.49
|
| Rate for Payer: Quartz Commercial |
$4,809.17
|
| Rate for Payer: WEA Trust Commercial |
$4,408.40
|
| Rate for Payer: WPS Commercial |
$5,936.70
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
|
OP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,923.67 |
| Max. Negotiated Rate |
$14,596.05 |
| Rate for Payer: Aetna Commercial |
$7,213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,893.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,248.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,374.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$7,133.60
|
| Rate for Payer: HFN Commercial |
$7,374.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$6,412.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,374.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,927.49
|
| Rate for Payer: Quartz Commercial |
$5,209.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$6,670.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$4,408.40
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$5,936.70
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
|
OP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,923.67 |
| Max. Negotiated Rate |
$14,596.05 |
| Rate for Payer: Aetna Commercial |
$9,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,289.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,937.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$9,613.28
|
| Rate for Payer: HFN Commercial |
$9,937.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$8,641.15
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$9,937.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.71
|
| Rate for Payer: Quartz Commercial |
$7,020.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$6,670.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$5,940.79
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$8,000.34
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
|
IP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,292.71 |
| Max. Negotiated Rate |
$9,937.32 |
| Rate for Payer: Aetna Commercial |
$9,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,289.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,724.76
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,937.32
|
| Rate for Payer: Health EOS Commercial |
$9,613.28
|
| Rate for Payer: HFN Commercial |
$9,937.32
|
| Rate for Payer: Multiplan Commercial |
$8,641.15
|
| Rate for Payer: Preferred Network Access Commercial |
$9,937.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,292.71
|
| Rate for Payer: Quartz Commercial |
$6,480.86
|
| Rate for Payer: WEA Trust Commercial |
$5,940.79
|
| Rate for Payer: WPS Commercial |
$8,000.34
|
|
|
ECCENTER TI SYNTHES
|
Facility
|
IP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.43 |
| Max. Negotiated Rate |
$4,677.80 |
| Rate for Payer: Aetna Commercial |
$4,576.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,372.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,694.82
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,677.80
|
| Rate for Payer: Health EOS Commercial |
$4,525.26
|
| Rate for Payer: HFN Commercial |
$4,677.80
|
| Rate for Payer: Multiplan Commercial |
$4,067.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,677.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.43
|
| Rate for Payer: Quartz Commercial |
$3,050.74
|
| Rate for Payer: WEA Trust Commercial |
$2,796.51
|
| Rate for Payer: WPS Commercial |
$3,766.00
|
|
|
ECCENTER TI SYNTHES
|
Facility
|
OP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.68 |
| Max. Negotiated Rate |
$4,677.80 |
| Rate for Payer: Aetna Commercial |
$4,576.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,372.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,423.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,304.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,542.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,440.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,694.82
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,677.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.40
|
| Rate for Payer: Health EOS Commercial |
$4,525.26
|
| Rate for Payer: HFN Commercial |
$4,677.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,813.42
|
| Rate for Payer: Multiplan Commercial |
$4,067.65
|
| Rate for Payer: NAPHCARE Commercial |
$3,050.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,677.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.43
|
| Rate for Payer: Quartz Commercial |
$3,304.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,050.74
|
| Rate for Payer: The Alliance Commercial |
$2,542.28
|
| Rate for Payer: WEA Trust Commercial |
$2,796.51
|
| Rate for Payer: WPS Commercial |
$3,766.00
|
|
|
ECG Monitor/Report 93224
|
Professional
|
Both
|
$2,895.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
3147545
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.10 |
| Max. Negotiated Rate |
$2,860.26 |
| Rate for Payer: Aetna Commercial |
$2,860.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.29
|
| Rate for Payer: Aetna Managed Medicare |
$70.10
|
| Rate for Payer: Anthem Medicare Advantage |
$70.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.10
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,860.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.10
|
| Rate for Payer: Health EOS Commercial |
$2,739.83
|
| Rate for Payer: HFN Commercial |
$2,860.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$279.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.10
|
| Rate for Payer: Multiplan Commercial |
$2,408.64
|
| Rate for Payer: NAPHCARE Commercial |
$105.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.75
|
| Rate for Payer: Quartz Commercial |
$1,716.16
|
| Rate for Payer: Quartz Medicare Advantage |
$70.10
|
| Rate for Payer: The Alliance Commercial |
$266.36
|
| Rate for Payer: United Healthcare Medicaid |
$111.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.10
|
| Rate for Payer: WEA Trust Commercial |
$1,655.94
|
| Rate for Payer: WPS Commercial |
$280.38
|
|
|
ECG Record/Review 93268
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
3165512
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.90 |
| Max. Negotiated Rate |
$698.04 |
| Rate for Payer: Aetna Commercial |
$593.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$168.90
|
| Rate for Payer: Anthem Medicare Advantage |
$168.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.90
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$593.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.90
|
| Rate for Payer: Health EOS Commercial |
$568.79
|
| Rate for Payer: HFN Commercial |
$593.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$698.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.90
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$253.34
|
| Rate for Payer: Preferred Network Access Commercial |
$593.79
|
| Rate for Payer: Quartz Beloit One Network |
$275.02
|
| Rate for Payer: Quartz Commercial |
$356.27
|
| Rate for Payer: Quartz Medicare Advantage |
$168.90
|
| Rate for Payer: The Alliance Commercial |
$641.80
|
| Rate for Payer: United Healthcare Medicaid |
$250.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.90
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$675.58
|
|
