|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$36,546.00
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$13,146.21 |
| Max. Negotiated Rate |
$36,546.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,146.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,146.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,146.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,146.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,146.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,146.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,570.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,146.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,146.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,146.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,146.21
|
| Rate for Payer: NAPHCARE Commercial |
$19,719.32
|
| Rate for Payer: Quartz Medicare Advantage |
$13,146.21
|
| Rate for Payer: The Alliance Commercial |
$36,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,146.21
|
| Rate for Payer: United Healthcare PPO |
$20,685.63
|
| Rate for Payer: Wellcare Medicare |
$13,146.21
|
|
|
HERNIA REPAIR, HIATAL/DIAPHRAGMATIC/NISSEN FUNDOPLICATION
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
HERNIA REPAIR, HIATAL/DIAPHRAGMATIC/NISSEN FUNDOPLICATION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
HERNIA REPAIR, INCISIONAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, INCISIONAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, INGUINAL/FEMORAL/SPIGELIAN
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, INGUINAL/FEMORAL/SPIGELIAN
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, INGUINAL PEDIATRIC
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
HERNIA REPAIR, INGUINAL PEDIATRIC
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
HERNIA REPAIR, PERISTOMAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
HERNIA REPAIR, PERISTOMAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960113
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
HERNIA REPAIR, UMBILICAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, UMBILICAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, VENTRAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
HERNIA REPAIR, VENTRAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
.Herpes Simplex 1 IgM Titer
|
Professional
|
Both
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Aetna Commercial |
$8.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.83
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.46
|
| Rate for Payer: Health EOS Commercial |
$8.28
|
| Rate for Payer: HFN Commercial |
$8.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Preferred Network Access Commercial |
$8.64
|
| Rate for Payer: Quartz Beloit One Network |
$4.00
|
| Rate for Payer: Quartz Commercial |
$5.19
|
| Rate for Payer: The Alliance Commercial |
$4.55
|
| Rate for Payer: WEA Trust Commercial |
$5.00
|
| Rate for Payer: WPS Commercial |
$6.74
|
|
|
.Herpes Simplex 1 IgM Titer
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.37 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.82
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: Health EOS Commercial |
$8.10
|
| Rate for Payer: HFN Commercial |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: NAPHCARE Commercial |
$5.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8.37
|
| Rate for Payer: Quartz Beloit One Network |
$4.46
|
| Rate for Payer: Quartz Commercial |
$5.46
|
| Rate for Payer: WEA Trust Commercial |
$5.00
|
| Rate for Payer: WPS Commercial |
$6.74
|
|
|
.Herpes Simplex 1 IgM Titer
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.83
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$13.63
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.09
|
| Rate for Payer: Dean Health Medicaid |
$13.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$8.10
|
| Rate for Payer: HFN Commercial |
$8.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$8.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.63
|
| Rate for Payer: Quartz Beloit One Network |
$4.46
|
| Rate for Payer: Quartz Commercial |
$5.92
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$13.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$6.82
|
| Rate for Payer: WEA Trust Commercial |
$5.00
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$13.63
|
| Rate for Payer: WPS Commercial |
$6.74
|
|
|
.Herpes Simplex 2 IgM Titer
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3376967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
.Herpes Simplex 2 IgM Titer
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3376967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.60
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: HFN Commercial |
$62.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: The Alliance Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
.Herpes Simplex 2 IgM Titer
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3376967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Herpes Simplex Antibody IgM
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
2943019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Herpes Simplex Antibody IgM
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
2943019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$337.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$337.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.00
|
| Rate for Payer: Health EOS Commercial |
$323.05
|
| Rate for Payer: HFN Commercial |
$337.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Preferred Network Access Commercial |
$337.25
|
| Rate for Payer: Quartz Beloit One Network |
$156.20
|
| Rate for Payer: Quartz Commercial |
$202.35
|
| Rate for Payer: The Alliance Commercial |
$177.50
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Herpes Simplex Antibody IgM
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
2943019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$57.56
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$266.25
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Herpes Simplex PCR Occular
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
6196142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
