|
IABP Activity - Insert New Site
|
Professional
|
Both
|
$9,674.00
|
|
| Hospital Charge Code |
3034564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.56 |
| Max. Negotiated Rate |
$9,190.30 |
| Rate for Payer: Aetna Commercial |
$9,190.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,319.64
|
| Rate for Payer: Cash Price |
$2,902.20
|
| Rate for Payer: Cigna Commercial |
$9,190.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,837.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,804.40
|
| Rate for Payer: Health EOS Commercial |
$8,803.34
|
| Rate for Payer: HFN Commercial |
$9,190.30
|
| Rate for Payer: Multiplan Commercial |
$7,739.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,190.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,256.56
|
| Rate for Payer: Quartz Commercial |
$5,514.18
|
| Rate for Payer: The Alliance Commercial |
$4,837.00
|
| Rate for Payer: WEA Trust Commercial |
$5,320.70
|
| Rate for Payer: WPS Commercial |
$7,165.53
|
|
|
IABP Activity - Insert New Site
|
Facility
|
OP
|
$9,674.00
|
|
| Hospital Charge Code |
3034564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,708.72 |
| Max. Negotiated Rate |
$38,696.00 |
| Rate for Payer: Aetna Commercial |
$8,706.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,319.64
|
| Rate for Payer: Aetna Managed Medicare |
$2,708.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,288.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,837.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,643.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,127.22
|
| Rate for Payer: Cash Price |
$2,902.20
|
| Rate for Payer: Cigna Commercial |
$8,900.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,413.57
|
| Rate for Payer: Health EOS Commercial |
$8,609.86
|
| Rate for Payer: HFN Commercial |
$8,900.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,255.50
|
| Rate for Payer: Multiplan Commercial |
$7,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,804.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,900.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,740.26
|
| Rate for Payer: Quartz Commercial |
$6,288.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5,804.40
|
| Rate for Payer: The Alliance Commercial |
$38,696.00
|
| Rate for Payer: WEA Trust Commercial |
$5,320.70
|
| Rate for Payer: WPS Commercial |
$7,165.53
|
|
|
IABP Activity - Insert New Site
|
Facility
|
IP
|
$9,674.00
|
|
| Hospital Charge Code |
3034564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,740.26 |
| Max. Negotiated Rate |
$8,900.08 |
| Rate for Payer: Aetna Commercial |
$8,706.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,319.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,127.22
|
| Rate for Payer: Cash Price |
$2,902.20
|
| Rate for Payer: Cigna Commercial |
$8,900.08
|
| Rate for Payer: Health EOS Commercial |
$8,609.86
|
| Rate for Payer: HFN Commercial |
$8,900.08
|
| Rate for Payer: Multiplan Commercial |
$7,739.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,804.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,900.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,740.26
|
| Rate for Payer: Quartz Commercial |
$5,804.40
|
| Rate for Payer: WEA Trust Commercial |
$5,320.70
|
| Rate for Payer: WPS Commercial |
$7,165.53
|
|
|
IABP Insertion
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
3052403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$323.68 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,040.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$994.16
|
| Rate for Payer: Aetna Managed Medicare |
$323.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$751.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$578.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$554.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$612.68
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,063.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,028.84
|
| Rate for Payer: HFN Commercial |
$1,063.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.00
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: NAPHCARE Commercial |
$693.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,063.52
|
| Rate for Payer: Quartz Beloit One Network |
$566.44
|
| Rate for Payer: Quartz Commercial |
$751.40
|
| Rate for Payer: Quartz Medicare Advantage |
$693.60
|
| Rate for Payer: The Alliance Commercial |
$4,624.00
|
| Rate for Payer: WEA Trust Commercial |
$635.80
|
| Rate for Payer: WPS Commercial |
$856.25
|
|
|
IABP Insertion
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
3052403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$566.44 |
| Max. Negotiated Rate |
$1,063.52 |
| Rate for Payer: Aetna Commercial |
$1,040.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$994.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$612.68
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,063.52
|
| Rate for Payer: Health EOS Commercial |
$1,028.84
|
| Rate for Payer: HFN Commercial |
$1,063.52
|
| Rate for Payer: Multiplan Commercial |
$924.80
|
| Rate for Payer: NAPHCARE Commercial |
$693.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,063.52
|
| Rate for Payer: Quartz Beloit One Network |
$566.44
|
| Rate for Payer: Quartz Commercial |
$693.60
|
| Rate for Payer: WEA Trust Commercial |
$635.80
|
| Rate for Payer: WPS Commercial |
$856.25
|
|
|
IABP Removal
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
3052404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
IABP Removal
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
3052404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$48.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$103.20
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
IBD ASCA IgA
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439034
|
|
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
|
|
|
IBD ASCA IgA
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.15 |
| 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 |
$12.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.34
|
| Rate for Payer: Anthem Medicaid |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Dean Health Medicaid |
$7.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.25
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.25
|
| Rate for Payer: Managed Health Services Medicaid |
$7.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.38
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.15
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.25
|
| Rate for Payer: The Alliance Commercial |
$49.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: Wellcare Medicare |
$12.25
|
| Rate for Payer: WMAP Medicaid |
$7.15
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
IBD ASCA IgA
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.24 |
| 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 |
$43.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.24
|
| 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
|
|
|
IBD ASCA IgG
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439033
|
|
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
|
|
|
IBD ASCA IgG
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.24 |
| 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 |
$43.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.24
|
| 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
|
|
|
IBD ASCA IgG
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5439033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.15 |
| 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 |
$12.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.34
|
| Rate for Payer: Anthem Medicaid |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.25
|
| 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 |
$12.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Dean Health Medicaid |
$7.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.25
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.25
|
| Rate for Payer: Managed Health Services Medicaid |
$7.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.25
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.38
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.15
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.25
|
| Rate for Payer: The Alliance Commercial |
$49.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: Wellcare Medicare |
$12.25
|
| Rate for Payer: WMAP Medicaid |
$7.15
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
IBD DNA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4597204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
IBD DNA
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4597204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$370.44 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Anthem Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.44
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
IBD DNA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4597204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$77.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.75
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$166.20
|
| Rate for Payer: The Alliance Commercial |
$1,108.00
|
| Rate for Payer: United Healthcare PPO |
$207.75
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
IBD Interp & Report
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
IBD Interp & Report
|
Professional
|
Both
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
IBD Interp & Report
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$32.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$69.60
|
| Rate for Payer: The Alliance Commercial |
$464.00
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
IBD SGI Diagnostic to Prometheus
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
IBD SGI Diagnostic to Prometheus
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
IBD SGI Diagnostic to Prometheus
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
IBS Diagnostic Chemiluminescent
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.80
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: HFN Commercial |
$88.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.84
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: The Alliance Commercial |
$46.50
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
IBS Diagnostic Chemiluminescent
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
IBS Diagnostic Chemiluminescent
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.44
|
| Rate for Payer: Anthem Medicaid |
$14.59
|
| Rate for Payer: Anthem Medicare Advantage |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.12
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Dean Health Medicaid |
$14.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.12
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.12
|
| Rate for Payer: Managed Health Services Medicaid |
$15.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.18
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.59
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.12
|
| Rate for Payer: The Alliance Commercial |
$56.48
|
| Rate for Payer: United Healthcare Medicaid |
$14.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare PPO |
$69.75
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$14.12
|
| Rate for Payer: WMAP Medicaid |
$14.59
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
