|
HEEL SPUR, REMOVAL
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2960102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
HEEL SPUR, REMOVAL
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2960102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
Helicobacter pylori Antigen, Stool
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
5575230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Helicobacter pylori Antigen, Stool
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
5575230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$14.96
|
| Rate for Payer: Anthem Medicare Advantage |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.96
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.96
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$22.43
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$14.96
|
| Rate for Payer: The Alliance Commercial |
$59.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.96
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$65.80
|
|
|
Helicobacter pylori Antigen, Stool
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
5575230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$14.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.83
|
| Rate for Payer: Anthem Medicare Advantage |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.96
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.96
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$22.43
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14.96
|
| Rate for Payer: The Alliance Commercial |
$59.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.96
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$14.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Helicobacter pylori Breath Test
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
978118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.59 |
| Max. Negotiated Rate |
$357.84 |
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.15
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$357.84
|
| Rate for Payer: Health EOS Commercial |
$346.17
|
| Rate for Payer: HFN Commercial |
$357.84
|
| Rate for Payer: Multiplan Commercial |
$311.17
|
| Rate for Payer: Preferred Network Access Commercial |
$357.84
|
| Rate for Payer: Quartz Beloit One Network |
$190.59
|
| Rate for Payer: Quartz Commercial |
$233.38
|
| Rate for Payer: WEA Trust Commercial |
$213.93
|
| Rate for Payer: WPS Commercial |
$288.09
|
|
|
Helicobacter pylori Breath Test
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
978118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$369.51 |
| Rate for Payer: Aetna Commercial |
$369.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.51
|
| Rate for Payer: Aetna Managed Medicare |
$70.05
|
| Rate for Payer: Anthem Medicare Advantage |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.05
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$369.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.05
|
| Rate for Payer: Health EOS Commercial |
$353.95
|
| Rate for Payer: HFN Commercial |
$369.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.05
|
| Rate for Payer: Multiplan Commercial |
$311.17
|
| Rate for Payer: NAPHCARE Commercial |
$105.08
|
| Rate for Payer: Preferred Network Access Commercial |
$369.51
|
| Rate for Payer: Quartz Beloit One Network |
$171.14
|
| Rate for Payer: Quartz Commercial |
$221.71
|
| Rate for Payer: Quartz Medicare Advantage |
$70.05
|
| Rate for Payer: The Alliance Commercial |
$276.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.05
|
| Rate for Payer: WEA Trust Commercial |
$213.93
|
| Rate for Payer: WPS Commercial |
$308.24
|
|
|
Helicobacter pylori Breath Test
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
978118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$357.84 |
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.51
|
| Rate for Payer: Aetna Managed Medicare |
$70.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.29
|
| Rate for Payer: Anthem Medicare Advantage |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.05
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$357.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$70.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$70.05
|
| Rate for Payer: Health EOS Commercial |
$346.17
|
| Rate for Payer: HFN Commercial |
$357.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$70.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$70.05
|
| Rate for Payer: Multiplan Commercial |
$311.17
|
| Rate for Payer: NAPHCARE Commercial |
$105.08
|
| Rate for Payer: Preferred Network Access Commercial |
$357.84
|
| Rate for Payer: Quartz Beloit One Network |
$190.59
|
| Rate for Payer: Quartz Commercial |
$252.82
|
| Rate for Payer: Quartz Medicare Advantage |
$70.05
|
| Rate for Payer: The Alliance Commercial |
$280.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.05
|
| Rate for Payer: United Healthcare PPO |
$291.72
|
| Rate for Payer: WEA Trust Commercial |
$213.93
|
| Rate for Payer: Wellcare Medicare |
$70.05
|
| Rate for Payer: WPS Commercial |
$288.09
|
|
|
Helicobacter pylori Culture
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3811600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Helicobacter pylori Culture
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3811600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$6.90
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Helicobacter pylori Culture
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3811600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$30.34
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$280.22 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$70.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.29
|
| Rate for Payer: Anthem Medicare Advantage |
$70.05
|
| 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 |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.05
|
| 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 |
$70.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$70.05
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$70.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$70.05
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$105.08
|
| 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 |
$70.05
|
| Rate for Payer: The Alliance Commercial |
$280.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.05
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$70.05
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$308.24 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$70.05
|
| Rate for Payer: Anthem Medicare Advantage |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.05
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.05
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$247.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.05
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$105.08
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$70.05
|
| Rate for Payer: The Alliance Commercial |
$276.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.05
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$308.24
|
|
|
HELMET GI PROCEDURE
|
Facility
|
IP
|
$2,671.00
|
|
| Hospital Charge Code |
3511504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,361.14 |
| Max. Negotiated Rate |
$2,555.61 |
| Rate for Payer: Aetna Commercial |
$2,500.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.26
|
| Rate for Payer: Cash Price |
$801.30
|
| Rate for Payer: Cigna Commercial |
$2,555.61
|
| Rate for Payer: Health EOS Commercial |
$2,472.28
|
| Rate for Payer: HFN Commercial |
$2,555.61
|
| Rate for Payer: Multiplan Commercial |
$2,222.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,555.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.14
|
| Rate for Payer: Quartz Commercial |
$1,666.70
|
| Rate for Payer: WEA Trust Commercial |
$1,527.81
|
| Rate for Payer: WPS Commercial |
$2,057.47
|
|
|
HELMET GI PROCEDURE
|
Facility
|
OP
|
$2,671.00
|
|
| Hospital Charge Code |
3511504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$2,555.61 |
| Rate for Payer: Aetna Commercial |
$2,500.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,388.94
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,805.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,388.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,333.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.26
|
| Rate for Payer: Cash Price |
$801.30
|
| Rate for Payer: Cigna Commercial |
$2,555.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,554.52
|
| Rate for Payer: Health EOS Commercial |
$2,472.28
|
| Rate for Payer: HFN Commercial |
$2,555.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,083.38
|
| Rate for Payer: Multiplan Commercial |
$2,222.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,666.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,555.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.14
|
| Rate for Payer: Quartz Commercial |
$1,805.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,666.70
|
| Rate for Payer: The Alliance Commercial |
$1,388.92
|
| Rate for Payer: WEA Trust Commercial |
$1,527.81
|
| Rate for Payer: WPS Commercial |
$2,057.47
|
|
|
HEMACLIP LARGE GREEN 523860
|
Facility
|
OP
|
$313.00
|
|
| Hospital Charge Code |
2965798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.15 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Aetna Managed Medicare |
$91.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$211.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.17
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.14
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: NAPHCARE Commercial |
$195.31
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$211.59
|
| Rate for Payer: Quartz Medicare Advantage |
$195.31
|
| Rate for Payer: The Alliance Commercial |
$162.76
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
HEMACLIP LARGE GREEN 523860
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
2965798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$195.31
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
HEMACLIP MEDIUM BLUE 523700
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2965797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
HEMACLIP MEDIUM BLUE 523700
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2965797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
HEMACLIP SMALL YELLOW 523735
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
2965799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
HEMACLIP SMALL YELLOW 523735
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
2965799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
Hematocrit
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$10.85
|
|
|
Hematocrit
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$39.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare PPO |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: Wellcare Medicare |
$2.46
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
Hematocrit
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
