|
Helicobacter pylori Culture
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3811600
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$225.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.20
|
| Rate for Payer: Health EOS Commercial |
$215.67
|
| Rate for Payer: HFN Commercial |
$225.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$225.15
|
| Rate for Payer: Quartz Beloit One Network |
$104.28
|
| Rate for Payer: Quartz Commercial |
$135.09
|
| Rate for Payer: The Alliance Commercial |
$118.50
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$269.44 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$67.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.82
|
| Rate for Payer: Anthem Medicaid |
$69.60
|
| Rate for Payer: Anthem Medicare Advantage |
$67.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.36
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicaid |
$69.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.36
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$69.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.36
|
| Rate for Payer: Managed Health Services Medicaid |
$72.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.36
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$101.04
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$69.60
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$67.36
|
| Rate for Payer: The Alliance Commercial |
$269.44
|
| Rate for Payer: United Healthcare Medicaid |
$69.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.36
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$67.36
|
| Rate for Payer: WMAP Medicaid |
$69.60
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$237.78 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$237.78
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Heliobacter pylori Breath Test Pediatric
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
6196271
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
HELMET GI PROCEDURE
|
Facility
|
OP
|
$2,671.00
|
|
| Hospital Charge Code |
3511504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$10,684.00 |
| Rate for Payer: Aetna Commercial |
$2,403.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,297.06
|
| Rate for Payer: Aetna Managed Medicare |
$747.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,736.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.63
|
| Rate for Payer: Cash Price |
$801.30
|
| Rate for Payer: Cigna Commercial |
$2,457.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,494.69
|
| Rate for Payer: Health EOS Commercial |
$2,377.19
|
| Rate for Payer: HFN Commercial |
$2,457.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,003.25
|
| Rate for Payer: Multiplan Commercial |
$2,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,457.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.79
|
| Rate for Payer: Quartz Commercial |
$1,736.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.60
|
| Rate for Payer: The Alliance Commercial |
$10,684.00
|
| Rate for Payer: WEA Trust Commercial |
$1,469.05
|
| Rate for Payer: WPS Commercial |
$1,978.41
|
|
|
HELMET GI PROCEDURE
|
Facility
|
IP
|
$2,671.00
|
|
| Hospital Charge Code |
3511504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,308.79 |
| Max. Negotiated Rate |
$2,457.32 |
| Rate for Payer: Aetna Commercial |
$2,403.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,297.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,415.63
|
| Rate for Payer: Cash Price |
$801.30
|
| Rate for Payer: Cigna Commercial |
$2,457.32
|
| Rate for Payer: Health EOS Commercial |
$2,377.19
|
| Rate for Payer: HFN Commercial |
$2,457.32
|
| Rate for Payer: Multiplan Commercial |
$2,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,602.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,457.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,308.79
|
| Rate for Payer: Quartz Commercial |
$1,602.60
|
| Rate for Payer: WEA Trust Commercial |
$1,469.05
|
| Rate for Payer: WPS Commercial |
$1,978.41
|
|
|
HEMACLIP LARGE GREEN 523860
|
Facility
|
IP
|
$313.00
|
|
| Hospital Charge Code |
2965798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
HEMACLIP LARGE GREEN 523860
|
Facility
|
OP
|
$313.00
|
|
| Hospital Charge Code |
2965798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.64 |
| Max. Negotiated Rate |
$1,252.00 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$87.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$203.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.75
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$187.80
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
HEMACLIP MEDIUM BLUE 523700
|
Facility
|
OP
|
$518.00
|
|
| Hospital Charge Code |
2965797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
HEMACLIP MEDIUM BLUE 523700
|
Facility
|
IP
|
$518.00
|
|
| Hospital Charge Code |
2965797
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
HEMACLIP SMALL YELLOW 523735
|
Facility
|
IP
|
$447.00
|
|
| Hospital Charge Code |
2965799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
HEMACLIP SMALL YELLOW 523735
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
2965799
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
Hematocrit
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Hematocrit
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$2.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.93
|
| Rate for Payer: Anthem Medicaid |
$2.45
|
| Rate for Payer: Anthem Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.37
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Dean Health Medicaid |
$2.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.37
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.37
|
| Rate for Payer: Managed Health Services Medicaid |
$2.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.56
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.45
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2.37
|
| Rate for Payer: The Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Medicaid |
$2.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: Wellcare Medicare |
$2.37
|
| Rate for Payer: WMAP Medicaid |
$2.45
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Hematocrit
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$34.80
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Hematocrit
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: HFN Commercial |
$114.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Hematocrit
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.80
|
| Rate for Payer: Health EOS Commercial |
$52.78
|
| Rate for Payer: HFN Commercial |
$55.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55.10
|
| Rate for Payer: Quartz Beloit One Network |
$25.52
|
| Rate for Payer: Quartz Commercial |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$29.00
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Hematocrit
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.93
|
| Rate for Payer: Anthem Medicaid |
$2.45
|
| Rate for Payer: Anthem Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.37
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.46
|
| Rate for Payer: Dean Health Medicaid |
$2.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.37
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.37
|
| Rate for Payer: Managed Health Services Medicaid |
$2.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$3.56
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.45
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$37.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.37
|
| Rate for Payer: The Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Medicaid |
$2.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare PPO |
$43.50
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: Wellcare Medicare |
$2.37
|
| Rate for Payer: WMAP Medicaid |
$2.45
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$1,205.40 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Aetna Managed Medicare |
$301.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,130.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$527.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.24
|
| Rate for Payer: Anthem Medicaid |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.35
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$301.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.51
|
| Rate for Payer: Dean Health Medicaid |
$301.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$301.35
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,121.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$301.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$301.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.35
|
| Rate for Payer: Managed Health Services Medicaid |
$313.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$301.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$301.35
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$452.02
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$301.35
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$529.10
|
| Rate for Payer: Quartz Medicare Advantage |
$301.35
|
| Rate for Payer: The Alliance Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare Medicaid |
$301.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.35
|
| Rate for Payer: United Healthcare PPO |
$610.50
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: Wellcare Medicare |
$301.35
|
| Rate for Payer: WMAP Medicaid |
$301.35
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$358.16 |
| Max. Negotiated Rate |
$1,063.77 |
| Rate for Payer: Aetna Commercial |
$773.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$773.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$407.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.40
|
| Rate for Payer: Health EOS Commercial |
$740.74
|
| Rate for Payer: HFN Commercial |
$773.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,063.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,063.77
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$773.30
|
| Rate for Payer: Quartz Beloit One Network |
$358.16
|
| Rate for Payer: Quartz Commercial |
$463.98
|
| Rate for Payer: The Alliance Commercial |
$407.00
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.86 |
| Max. Negotiated Rate |
$748.88 |
| Rate for Payer: Aetna Commercial |
$732.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.42
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$748.88
|
| Rate for Payer: Health EOS Commercial |
$724.46
|
| Rate for Payer: HFN Commercial |
$748.88
|
| Rate for Payer: Multiplan Commercial |
$651.20
|
| Rate for Payer: NAPHCARE Commercial |
$488.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.88
|
| Rate for Payer: Quartz Beloit One Network |
$398.86
|
| Rate for Payer: Quartz Commercial |
$488.40
|
| Rate for Payer: WEA Trust Commercial |
$447.70
|
| Rate for Payer: WPS Commercial |
$602.93
|
|
|
HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2950473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2950473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
HEMO CONCENTRATOR HPH-400TS
|
Facility
|
OP
|
$1,751.00
|
|
| Hospital Charge Code |
2965303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
HEMO CONCENTRATOR HPH-400TS
|
Facility
|
IP
|
$1,751.00
|
|
| Hospital Charge Code |
2965303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
