|
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 |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
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 |
$171.36 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.36
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| 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 |
$328.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$232.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
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 |
$174.93 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$214.20
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$214.20
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
EEG - AWAKE
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058211
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$845.74 |
| Max. Negotiated Rate |
$1,587.92 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,035.60
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
EEG - AWAKE
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058218
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$814.38 |
| Max. Negotiated Rate |
$1,529.04 |
| Rate for Payer: Aetna Commercial |
$1,495.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,429.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.86
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$1,529.04
|
| Rate for Payer: Health EOS Commercial |
$1,479.18
|
| Rate for Payer: HFN Commercial |
$1,529.04
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$997.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,529.04
|
| Rate for Payer: Quartz Beloit One Network |
$814.38
|
| Rate for Payer: Quartz Commercial |
$997.20
|
| Rate for Payer: WEA Trust Commercial |
$914.10
|
| Rate for Payer: WPS Commercial |
$1,231.04
|
|
|
EEG - AWAKE
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058218
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,529.04 |
| Rate for Payer: Aetna Commercial |
$1,495.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,429.32
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,080.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$831.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$797.76
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cash Price |
$498.60
|
| Rate for Payer: Cigna Commercial |
$1,529.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$930.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,479.18
|
| Rate for Payer: HFN Commercial |
$1,529.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,529.04
|
| Rate for Payer: Quartz Beloit One Network |
$814.38
|
| Rate for Payer: Quartz Commercial |
$1,080.30
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,246.50
|
| Rate for Payer: WEA Trust Commercial |
$914.10
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,231.04
|
|
|
EEG - AWAKE
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
CPT 95816
|
| Hospital Charge Code |
3058211
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,587.92 |
| Rate for Payer: Aetna Commercial |
$1,553.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,484.36
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$863.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.48
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,587.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,536.14
|
| Rate for Payer: HFN Commercial |
$1,587.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,380.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.92
|
| Rate for Payer: Quartz Beloit One Network |
$845.74
|
| Rate for Payer: Quartz Commercial |
$1,121.90
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,294.50
|
| Rate for Payer: WEA Trust Commercial |
$949.30
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,278.45
|
|
|
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 |
$196.34 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.34
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: The Alliance Commercial |
$269.00
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
EEG, AWAKE & SLEEP
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058219
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$946.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.88
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
EEG, AWAKE & SLEEP
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058219
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
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 |
$176.44 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$380.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.60
|
| Rate for Payer: Health EOS Commercial |
$364.91
|
| Rate for Payer: HFN Commercial |
$380.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.50
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$380.95
|
| Rate for Payer: Quartz Beloit One Network |
$176.44
|
| Rate for Payer: Quartz Commercial |
$228.57
|
| Rate for Payer: The Alliance Commercial |
$200.50
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
EEG Sleep Deprived
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3101728
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
EEG Sleep Deprived
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3101728
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$946.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.88
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
E. Equine encephalitis virus IgM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
E. Equine encephalitis virus IgM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
E. Equine encephalitis virus IgM
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Ehrlichia chaffeensis DNA, PCR
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5412830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Ehrlichia chaffeensis DNA, PCR
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5412830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$322.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$322.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.40
|
| Rate for Payer: Health EOS Commercial |
$308.49
|
| Rate for Payer: HFN Commercial |
$322.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$322.05
|
| Rate for Payer: Quartz Beloit One Network |
$149.16
|
| Rate for Payer: Quartz Commercial |
$193.23
|
| Rate for Payer: The Alliance Commercial |
$169.50
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Ehrlichia chaffeensis DNA, PCR
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5412830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$254.25
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Ehrlichia chaffeensis IgG
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$393.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$376.74
|
| Rate for Payer: HFN Commercial |
$393.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$393.30
|
| Rate for Payer: Quartz Beloit One Network |
$182.16
|
| Rate for Payer: Quartz Commercial |
$235.98
|
| Rate for Payer: The Alliance Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Ehrlichia chaffeensis IgG
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Ehrlichia chaffeensis IgG
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.72
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Ehrlichia chaffeensis IgM
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Ehrlichia chaffeensis IgM
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.72
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Ehrlichia chaffeensis IgM
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$393.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$376.74
|
| Rate for Payer: HFN Commercial |
$393.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$393.30
|
| Rate for Payer: Quartz Beloit One Network |
$182.16
|
| Rate for Payer: Quartz Commercial |
$235.98
|
| Rate for Payer: The Alliance Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
