|
ED Tympanostomy With Tube
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
6174446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.07 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$567.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Anthem Medicare Advantage |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$567.58
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$567.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$567.58
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,111.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$567.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$567.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$567.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$567.58
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$851.37
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$567.58
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: Wellcare Medicare |
$567.58
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
ED Tympanostomy With Tube
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
6174446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
ED Unna Boot
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
6173882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
ED Unna Boot
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
6173882
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.91
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
ED Ureteral endoscopy & treatment
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
6177680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$20,990.83 |
| Rate for Payer: Aetna Commercial |
$607.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.47
|
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$323.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,642.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Health EOS Commercial |
$600.71
|
| Rate for Payer: HFN Commercial |
$620.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,990.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,642.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,642.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,642.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$539.97
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Preferred Network Access Commercial |
$620.96
|
| Rate for Payer: Quartz Beloit One Network |
$330.73
|
| Rate for Payer: Quartz Commercial |
$438.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5,642.70
|
| Rate for Payer: The Alliance Commercial |
$9,592.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,642.70
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$371.23
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
| Rate for Payer: WPS Commercial |
$499.92
|
|
|
ED Ureteral endoscopy & treatment
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
6177680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.73 |
| Max. Negotiated Rate |
$620.96 |
| Rate for Payer: Aetna Commercial |
$607.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.73
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Health EOS Commercial |
$600.71
|
| Rate for Payer: HFN Commercial |
$620.96
|
| Rate for Payer: Multiplan Commercial |
$539.97
|
| Rate for Payer: Preferred Network Access Commercial |
$620.96
|
| Rate for Payer: Quartz Beloit One Network |
$330.73
|
| Rate for Payer: Quartz Commercial |
$404.98
|
| Rate for Payer: WEA Trust Commercial |
$371.23
|
| Rate for Payer: WPS Commercial |
$499.92
|
|
|
ED US Vasc Access Sits Vsl Patency NDL Entry
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
6181795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$313.04 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$159.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ED US Vasc Access Sits Vsl Patency NDL Entry
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
6181795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
ED Wedge excision of skin of nail fold (eg, for ingrown toenail)
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
6173862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$222.77
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
ED Wedge excision of skin of nail fold (eg, for ingrown toenail)
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
6173862
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.21
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$241.33
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
EEG - AWAKE
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058218
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$846.96 |
| Max. Negotiated Rate |
$1,590.20 |
| Rate for Payer: Aetna Commercial |
$1,555.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,486.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$916.09
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$1,590.20
|
| Rate for Payer: Health EOS Commercial |
$1,538.35
|
| Rate for Payer: HFN Commercial |
$1,590.20
|
| Rate for Payer: Multiplan Commercial |
$1,382.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,590.20
|
| Rate for Payer: Quartz Beloit One Network |
$846.96
|
| Rate for Payer: Quartz Commercial |
$1,037.09
|
| Rate for Payer: WEA Trust Commercial |
$950.66
|
| Rate for Payer: WPS Commercial |
$1,280.24
|
|
|
EEG - AWAKE
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058218
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,590.20 |
| Rate for Payer: Aetna Commercial |
$1,555.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,486.49
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,123.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$864.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$829.67
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$916.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$1,590.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$967.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,538.35
|
| Rate for Payer: HFN Commercial |
$1,590.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,382.78
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,590.20
|
| Rate for Payer: Quartz Beloit One Network |
$846.96
|
| Rate for Payer: Quartz Commercial |
$1,123.51
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,296.36
|
| Rate for Payer: WEA Trust Commercial |
$950.66
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,280.24
|
|
|
EEG - AWAKE
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058211
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,651.44 |
| Rate for Payer: Aetna Commercial |
$1,615.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,543.73
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,166.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$897.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$861.62
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,651.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,004.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,597.59
|
| Rate for Payer: HFN Commercial |
$1,651.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,436.03
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.44
|
| Rate for Payer: Quartz Beloit One Network |
$879.57
|
| Rate for Payer: Quartz Commercial |
$1,166.78
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,346.28
|
| Rate for Payer: WEA Trust Commercial |
$987.27
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,329.54
|
|
|
EEG - AWAKE
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058211
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$879.57 |
| Max. Negotiated Rate |
$1,651.44 |
| Rate for Payer: Aetna Commercial |
$1,615.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,543.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.37
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,651.44
|
| Rate for Payer: Health EOS Commercial |
$1,597.59
|
| Rate for Payer: HFN Commercial |
$1,651.44
|
| Rate for Payer: Multiplan Commercial |
$1,436.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.44
|
| Rate for Payer: Quartz Beloit One Network |
$879.57
|
| Rate for Payer: Quartz Commercial |
$1,077.02
|
| Rate for Payer: WEA Trust Commercial |
$987.27
|
| Rate for Payer: WPS Commercial |
$1,329.54
|
|
|
EEG, Awake and Drowsy 9581626
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 95816 26
|
| Hospital Charge Code |
3975036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Aetna Commercial |
$531.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Aetna Managed Medicare |
$56.64
|
| Rate for Payer: Anthem Medicare Advantage |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.64
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$531.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.64
|
| Rate for Payer: Health EOS Commercial |
$509.16
|
| Rate for Payer: HFN Commercial |
$531.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.64
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: NAPHCARE Commercial |
$84.96
|
| Rate for Payer: Preferred Network Access Commercial |
$531.54
|
| Rate for Payer: Quartz Beloit One Network |
$246.19
|
| Rate for Payer: Quartz Commercial |
$318.93
|
| Rate for Payer: Quartz Medicare Advantage |
$56.64
|
| Rate for Payer: The Alliance Commercial |
$141.60
|
| Rate for Payer: United Healthcare Medicaid |
$43.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.64
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: WPS Commercial |
$226.55
|
|
|
EEG, AWAKE & SLEEP
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058219
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.84
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$984.26
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,135.68
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
EEG, AWAKE & SLEEP
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058219
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$741.98 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$908.54
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
EEG RECORD COMA/SLEEP ONLY 9582226
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 95822 26
|
| Hospital Charge Code |
6182585
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$396.19 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$56.97
|
| Rate for Payer: Anthem Medicare Advantage |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.97
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$396.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.97
|
| Rate for Payer: Health EOS Commercial |
$379.51
|
| Rate for Payer: HFN Commercial |
$396.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$205.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.97
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$85.46
|
| Rate for Payer: Preferred Network Access Commercial |
$396.19
|
| Rate for Payer: Quartz Beloit One Network |
$183.50
|
| Rate for Payer: Quartz Commercial |
$237.71
|
| Rate for Payer: Quartz Medicare Advantage |
$56.97
|
| Rate for Payer: The Alliance Commercial |
$142.43
|
| Rate for Payer: United Healthcare Medicaid |
$42.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$227.88
|
|
|
EEG Sleep Deprived
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3101728
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.84
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$984.26
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,135.68
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
EEG Sleep Deprived
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3101728
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$741.98 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$908.54
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
E. Equine encephalitis virus IgM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| 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 |
$29.21
|
| 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 |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| 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 |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| 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 |
$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 |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
E. Equine encephalitis virus IgM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
E. Equine encephalitis virus IgM
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$60.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| 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 |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| 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 |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| 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 |
$30.32
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Ehrlichia chaffeensis DNA, PCR
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5412830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$334.93 |
| Rate for Payer: Aetna Commercial |
$334.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| 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 |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$334.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$320.83
|
| Rate for Payer: HFN Commercial |
$334.93
|
| 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 |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$334.93
|
| Rate for Payer: Quartz Beloit One Network |
$155.13
|
| Rate for Payer: Quartz Commercial |
$200.96
|
| 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 |
$193.91
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Ehrlichia chaffeensis DNA, PCR
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5412830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
