|
Hereditary Erythrocytosis Mutations
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,128.00 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$358.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.41
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.50
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| Rate for Payer: Quartz Medicare Advantage |
$769.20
|
| Rate for Payer: The Alliance Commercial |
$5,128.00
|
| Rate for Payer: United Healthcare PPO |
$961.50
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
Hereditary Erythrocytosis Mutations
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$564.08 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Aetna Commercial |
$1,217.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,217.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$641.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.20
|
| Rate for Payer: Health EOS Commercial |
$1,166.62
|
| Rate for Payer: HFN Commercial |
$1,217.90
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,217.90
|
| Rate for Payer: Quartz Beloit One Network |
$564.08
|
| Rate for Payer: Quartz Commercial |
$730.74
|
| Rate for Payer: The Alliance Commercial |
$641.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$800.40 |
| Rate for Payer: Aetna Commercial |
$783.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.10
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$800.40
|
| Rate for Payer: Health EOS Commercial |
$774.30
|
| Rate for Payer: HFN Commercial |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: NAPHCARE Commercial |
$522.00
|
| Rate for Payer: Preferred Network Access Commercial |
$800.40
|
| Rate for Payer: Quartz Beloit One Network |
$426.30
|
| Rate for Payer: Quartz Commercial |
$522.00
|
| Rate for Payer: WEA Trust Commercial |
$478.50
|
| Rate for Payer: WPS Commercial |
$644.41
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.36 |
| Max. Negotiated Rate |
$800.40 |
| Rate for Payer: Aetna Commercial |
$783.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.20
|
| Rate for Payer: Aetna Managed Medicare |
$65.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.50
|
| Rate for Payer: Anthem Medicaid |
$67.54
|
| Rate for Payer: Anthem Medicare Advantage |
$65.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.36
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$800.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.85
|
| Rate for Payer: Dean Health Medicaid |
$67.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65.36
|
| Rate for Payer: Health EOS Commercial |
$774.30
|
| Rate for Payer: HFN Commercial |
$800.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$67.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.36
|
| Rate for Payer: Managed Health Services Medicaid |
$70.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65.36
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: NAPHCARE Commercial |
$98.04
|
| Rate for Payer: Preferred Network Access Commercial |
$800.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$67.54
|
| Rate for Payer: Quartz Beloit One Network |
$426.30
|
| Rate for Payer: Quartz Commercial |
$565.50
|
| Rate for Payer: Quartz Medicare Advantage |
$65.36
|
| Rate for Payer: The Alliance Commercial |
$261.44
|
| Rate for Payer: United Healthcare Medicaid |
$67.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.36
|
| Rate for Payer: United Healthcare PPO |
$652.50
|
| Rate for Payer: WEA Trust Commercial |
$478.50
|
| Rate for Payer: Wellcare Medicare |
$65.36
|
| Rate for Payer: WMAP Medicaid |
$67.54
|
| Rate for Payer: WPS Commercial |
$644.41
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.72 |
| Max. Negotiated Rate |
$826.50 |
| Rate for Payer: Aetna Commercial |
$826.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.20
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$826.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$435.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.00
|
| Rate for Payer: Health EOS Commercial |
$791.70
|
| Rate for Payer: HFN Commercial |
$826.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.72
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Preferred Network Access Commercial |
$826.50
|
| Rate for Payer: Quartz Beloit One Network |
$382.80
|
| Rate for Payer: Quartz Commercial |
$495.90
|
| Rate for Payer: The Alliance Commercial |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$478.50
|
| Rate for Payer: WPS Commercial |
$644.41
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Facility
|
IP
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,405.01 |
| Max. Negotiated Rate |
$6,393.08 |
| Rate for Payer: Aetna Commercial |
$6,254.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,976.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,682.97
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,393.08
|
| Rate for Payer: Health EOS Commercial |
$6,184.61
|
| Rate for Payer: HFN Commercial |
$6,393.08
|
| Rate for Payer: Multiplan Commercial |
$5,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,169.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,393.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,405.01
|
| Rate for Payer: Quartz Commercial |
$4,169.40
|
| Rate for Payer: WEA Trust Commercial |
$3,821.95
|
| Rate for Payer: WPS Commercial |
$5,147.12
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,057.56 |
| Max. Negotiated Rate |
$8,643.42 |
| Rate for Payer: Aetna Commercial |
$6,601.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,976.14
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,601.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,474.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,169.40
|
| Rate for Payer: Health EOS Commercial |
$6,323.59
|
| Rate for Payer: HFN Commercial |
$6,601.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,643.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,643.42
|
| Rate for Payer: Multiplan Commercial |
$5,559.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,601.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,057.56
|
| Rate for Payer: Quartz Commercial |
$3,960.93
|
| Rate for Payer: The Alliance Commercial |
$3,474.50
|
| Rate for Payer: WEA Trust Commercial |
$3,821.95
|
| Rate for Payer: WPS Commercial |
$5,147.12
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Facility
|
OP
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,448.56 |
| Max. Negotiated Rate |
$9,794.24 |
| Rate for Payer: Aetna Commercial |
$6,254.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,976.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,448.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,182.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,284.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,064.61
|
| Rate for Payer: Anthem Medicare Advantage |
$2,448.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,682.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,448.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,448.56
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,393.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,448.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,888.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,448.56
|
| Rate for Payer: Health EOS Commercial |
$6,184.61
|
| Rate for Payer: HFN Commercial |
$6,393.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,108.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,448.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,448.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,448.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,448.56
|
| Rate for Payer: Multiplan Commercial |
$5,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,672.84
|
| Rate for Payer: Preferred Network Access Commercial |
$6,393.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,405.01
|
| Rate for Payer: Quartz Commercial |
$4,516.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,448.56
|
| Rate for Payer: The Alliance Commercial |
$9,794.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,448.56
|
| Rate for Payer: United Healthcare PPO |
$5,211.75
|
| Rate for Payer: WEA Trust Commercial |
$3,821.95
|
| Rate for Payer: Wellcare Medicare |
$2,448.56
|
| Rate for Payer: WPS Commercial |
$5,147.12
|
|
|
Her Hem Amp Target Nuclic Acid
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Her Hem Amp Target Nuclic Acid
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Her Hem Amp Target Nuclic Acid
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Her Hem Enzymatic Digestion
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Her Hem Enzymatic Digestion
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$25.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$55.20
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Her Hem Enzymatic Digestion
|
Professional
|
Both
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$83.72
|
| Rate for Payer: HFN Commercial |
$87.40
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Preferred Network Access Commercial |
$87.40
|
| Rate for Payer: Quartz Beloit One Network |
$40.48
|
| Rate for Payer: Quartz Commercial |
$52.44
|
| Rate for Payer: The Alliance Commercial |
$46.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Her Hem Interp & Report
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Her Hem Interp & Report
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Her Hem Interp & Report
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$31.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Her Hem Sep & ID High Res
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Her Hem Sep & ID High Res
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Her Hem Sep & ID High Res
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$45,990.00
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$16,543.10 |
| Max. Negotiated Rate |
$45,990.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,543.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,085.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,659.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,278.16
|
| Rate for Payer: Anthem Medicare Advantage |
$16,543.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,543.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,543.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,543.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,171.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,543.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,497.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,543.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,543.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,543.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,543.10
|
| Rate for Payer: NAPHCARE Commercial |
$24,814.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16,543.10
|
| Rate for Payer: The Alliance Commercial |
$45,990.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,543.10
|
| Rate for Payer: United Healthcare PPO |
$26,077.92
|
| Rate for Payer: Wellcare Medicare |
$16,543.10
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$78,066.00
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$28,081.21 |
| Max. Negotiated Rate |
$78,066.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,081.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,261.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,956.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,611.76
|
| Rate for Payer: Anthem Medicare Advantage |
$28,081.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,081.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,081.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,081.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49,523.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,081.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,023.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,081.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,081.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,081.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,081.21
|
| Rate for Payer: NAPHCARE Commercial |
$42,121.82
|
| Rate for Payer: Quartz Medicare Advantage |
$28,081.21
|
| Rate for Payer: The Alliance Commercial |
$78,066.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,081.21
|
| Rate for Payer: United Healthcare PPO |
$44,393.80
|
| Rate for Payer: Wellcare Medicare |
$28,081.21
|
|
