|
Fetomaternal Bleed, Flow Cytometry to Mayo
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3331571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$377.23 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$807.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$771.87
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$825.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$798.79
|
| Rate for Payer: HFN Commercial |
$825.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$718.02
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$825.72
|
| Rate for Payer: Quartz Beloit One Network |
$439.78
|
| Rate for Payer: Quartz Commercial |
$583.39
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$673.14
|
| Rate for Payer: WEA Trust Commercial |
$493.64
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$664.77
|
|
|
Fetomaternal Bleed, Flow Cytometry to Mayo
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3331571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$439.78 |
| Max. Negotiated Rate |
$825.72 |
| Rate for Payer: Aetna Commercial |
$807.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$771.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.69
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$825.72
|
| Rate for Payer: Health EOS Commercial |
$798.79
|
| Rate for Payer: HFN Commercial |
$825.72
|
| Rate for Payer: Multiplan Commercial |
$718.02
|
| Rate for Payer: Preferred Network Access Commercial |
$825.72
|
| Rate for Payer: Quartz Beloit One Network |
$439.78
|
| Rate for Payer: Quartz Commercial |
$538.51
|
| Rate for Payer: WEA Trust Commercial |
$493.64
|
| Rate for Payer: WPS Commercial |
$664.77
|
|
|
FEVER
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00807
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Anthem Medicaid |
$90.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health Medicaid |
$90.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.71
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.71
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$12,012.58
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$10,670.33 |
| Max. Negotiated Rate |
$12,012.58 |
| Rate for Payer: Anthem Medicaid |
$11,502.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,502.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,502.71
|
| Rate for Payer: Dean Health Medicaid |
$11,502.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,670.33
|
| Rate for Payer: Managed Health Services Medicaid |
$12,012.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,502.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,502.71
|
| Rate for Payer: United Healthcare Medicaid |
$11,502.71
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$24,742.64
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$7,304.96 |
| Max. Negotiated Rate |
$24,742.64 |
| Rate for Payer: Aetna Managed Medicare |
$7,304.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,846.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,104.77
|
| Rate for Payer: Anthem Medicare Advantage |
$7,304.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,304.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,304.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,304.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,657.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,304.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,903.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,304.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,304.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,304.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,304.96
|
| Rate for Payer: NAPHCARE Commercial |
$10,957.44
|
| Rate for Payer: Quartz Medicare Advantage |
$7,304.96
|
| Rate for Payer: The Alliance Commercial |
$24,742.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,304.96
|
| Rate for Payer: United Healthcare PPO |
$13,937.86
|
| Rate for Payer: Wellcare Medicare |
$7,304.96
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$4,121.11
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$3,660.62 |
| Max. Negotiated Rate |
$4,121.11 |
| Rate for Payer: Anthem Medicaid |
$3,946.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,946.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,946.19
|
| Rate for Payer: Dean Health Medicaid |
$3,946.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,660.62
|
| Rate for Payer: Managed Health Services Medicaid |
$4,121.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,946.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,946.19
|
| Rate for Payer: United Healthcare Medicaid |
$3,946.19
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$7,716.11
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$6,853.93 |
| Max. Negotiated Rate |
$7,716.11 |
| Rate for Payer: Anthem Medicaid |
$7,388.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,388.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,388.60
|
| Rate for Payer: Dean Health Medicaid |
$7,388.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,853.93
|
| Rate for Payer: Managed Health Services Medicaid |
$7,716.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,388.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,388.60
|
| Rate for Payer: United Healthcare Medicaid |
$7,388.60
|
|
|
Fever Detector Stat Temp
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
3101745
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
Fever Detector Stat Temp
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
3101745
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
FFP 1
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052846
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP 1
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052846
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP 2
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052848
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP 2
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052848
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP CP2D
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052855
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP CP2D
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052855
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP CPD
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052866
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFP CPD
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052866
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
FFR Coronary/BPG +
|
Facility
|
OP
|
$3,132.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
3052504
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$912.04 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Aetna Managed Medicare |
$912.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,117.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,628.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,563.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,822.82
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,442.96
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$2,117.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,954.37
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
FFR Coronary/BPG +
|
Facility
|
IP
|
$3,132.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
3052504
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,596.07 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$1,954.37
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
FFR Coronary/BPG Ea Add Vessel +
|
Facility
|
OP
|
$2,870.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
4125706
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$835.74 |
| Max. Negotiated Rate |
$2,746.02 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Aetna Managed Medicare |
$835.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,940.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,492.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,670.34
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,238.60
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: NAPHCARE Commercial |
$1,790.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,940.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,790.88
|
| Rate for Payer: The Alliance Commercial |
$1,492.40
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
FFR Coronary/BPG Ea Add Vessel +
|
Facility
|
IP
|
$2,870.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
4125706
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,462.55 |
| Max. Negotiated Rate |
$2,746.02 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,790.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
FFR Wire
|
Facility
|
IP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4139303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,176.50 |
| Max. Negotiated Rate |
$4,086.49 |
| Rate for Payer: Aetna Commercial |
$3,997.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,819.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,354.18
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$4,086.49
|
| Rate for Payer: Health EOS Commercial |
$3,953.24
|
| Rate for Payer: HFN Commercial |
$4,086.49
|
| Rate for Payer: Multiplan Commercial |
$3,553.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,086.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,176.50
|
| Rate for Payer: Quartz Commercial |
$2,665.10
|
| Rate for Payer: WEA Trust Commercial |
$2,443.01
|
| Rate for Payer: WPS Commercial |
$3,289.95
|
|
|
FFR Wire
|
Facility
|
OP
|
$4,271.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4139303
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,243.72 |
| Max. Negotiated Rate |
$4,086.49 |
| Rate for Payer: Aetna Commercial |
$3,997.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,819.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,243.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,887.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,220.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,132.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,354.18
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$4,086.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,485.72
|
| Rate for Payer: Health EOS Commercial |
$3,953.24
|
| Rate for Payer: HFN Commercial |
$4,086.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,331.38
|
| Rate for Payer: Multiplan Commercial |
$3,553.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,665.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,086.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,176.50
|
| Rate for Payer: Quartz Commercial |
$2,887.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,665.10
|
| Rate for Payer: The Alliance Commercial |
$2,220.92
|
| Rate for Payer: WEA Trust Commercial |
$2,443.01
|
| Rate for Payer: WPS Commercial |
$3,289.95
|
|
|
F/G SHM 2.4/4/120-0/16MM M0063801070
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
4520072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$774.59 |
| Max. Negotiated Rate |
$2,545.09 |
| Rate for Payer: Aetna Commercial |
$2,489.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,379.10
|
| Rate for Payer: Aetna Managed Medicare |
$774.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,798.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,383.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,327.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,466.19
|
| Rate for Payer: Cash Price |
$798.00
|
| Rate for Payer: Cigna Commercial |
$2,545.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,548.12
|
| Rate for Payer: Health EOS Commercial |
$2,462.10
|
| Rate for Payer: HFN Commercial |
$2,545.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,074.80
|
| Rate for Payer: Multiplan Commercial |
$2,213.12
|
| Rate for Payer: NAPHCARE Commercial |
$1,659.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,545.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,355.54
|
| Rate for Payer: Quartz Commercial |
$1,798.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,659.84
|
| Rate for Payer: The Alliance Commercial |
$1,383.20
|
| Rate for Payer: WEA Trust Commercial |
$1,521.52
|
| Rate for Payer: WPS Commercial |
$2,049.00
|
|
