|
IBD DNA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
4597204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
IBD Interp & Report
|
Professional
|
Both
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.38
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
IBD Interp & Report
|
Facility
|
OP
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$33.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.48
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$72.38
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
IBD Interp & Report
|
Facility
|
IP
|
$116.00
|
|
| Hospital Charge Code |
2808809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
IBD SGI Diagnostic to Prometheus
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
IBD SGI Diagnostic to Prometheus
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.85
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
IBD SGI Diagnostic to Prometheus
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3062684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
IBS Diagnostic Chemiluminescent
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$14.68
|
| Rate for Payer: Anthem Medicare Advantage |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.68
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.68
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.68
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.03
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$14.68
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.68
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$64.61
|
|
|
IBS Diagnostic Chemiluminescent
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$14.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.68
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.68
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.68
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$14.68
|
| Rate for Payer: The Alliance Commercial |
$58.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.68
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$14.68
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
IBS Diagnostic Chemiluminescent
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
2776799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
ICAST STENT 10MM X 38MM -80CM
|
Facility
|
OP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.59 |
| Max. Negotiated Rate |
$9,047.50 |
| Rate for Payer: Aetna Commercial |
$8,850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,457.45
|
| Rate for Payer: Aetna Managed Medicare |
$2,753.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,392.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,917.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,720.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$9,047.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,503.39
|
| Rate for Payer: Health EOS Commercial |
$8,752.47
|
| Rate for Payer: HFN Commercial |
$9,047.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,375.68
|
| Rate for Payer: Multiplan Commercial |
$7,867.39
|
| Rate for Payer: NAPHCARE Commercial |
$5,900.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,047.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,818.78
|
| Rate for Payer: Quartz Commercial |
$6,392.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5,900.54
|
| Rate for Payer: The Alliance Commercial |
$4,917.12
|
| Rate for Payer: WEA Trust Commercial |
$5,408.83
|
| Rate for Payer: WPS Commercial |
$7,283.96
|
|
|
ICAST STENT 10MM X 38MM -80CM
|
Facility
|
IP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.78 |
| Max. Negotiated Rate |
$9,047.50 |
| Rate for Payer: Aetna Commercial |
$8,850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,457.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$9,047.50
|
| Rate for Payer: Health EOS Commercial |
$8,752.47
|
| Rate for Payer: HFN Commercial |
$9,047.50
|
| Rate for Payer: Multiplan Commercial |
$7,867.39
|
| Rate for Payer: Preferred Network Access Commercial |
$9,047.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,818.78
|
| Rate for Payer: Quartz Commercial |
$5,900.54
|
| Rate for Payer: WEA Trust Commercial |
$5,408.83
|
| Rate for Payer: WPS Commercial |
$7,283.96
|
|
|
ICAST STENT 7MM X 38MM -80CM
|
Facility
|
IP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.78 |
| Max. Negotiated Rate |
$9,047.50 |
| Rate for Payer: Aetna Commercial |
$8,850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,457.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$9,047.50
|
| Rate for Payer: Health EOS Commercial |
$8,752.47
|
| Rate for Payer: HFN Commercial |
$9,047.50
|
| Rate for Payer: Multiplan Commercial |
$7,867.39
|
| Rate for Payer: Preferred Network Access Commercial |
$9,047.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,818.78
|
| Rate for Payer: Quartz Commercial |
$5,900.54
|
| Rate for Payer: WEA Trust Commercial |
$5,408.83
|
| Rate for Payer: WPS Commercial |
$7,283.96
|
|
|
ICAST STENT 7MM X 38MM -80CM
|
Facility
|
OP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.59 |
| Max. Negotiated Rate |
$9,047.50 |
| Rate for Payer: Aetna Commercial |
$8,850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,457.45
|
| Rate for Payer: Aetna Managed Medicare |
$2,753.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,392.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,917.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,720.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$9,047.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,503.39
|
| Rate for Payer: Health EOS Commercial |
$8,752.47
|
| Rate for Payer: HFN Commercial |
$9,047.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,375.68
|
| Rate for Payer: Multiplan Commercial |
$7,867.39
|
| Rate for Payer: NAPHCARE Commercial |
$5,900.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,047.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,818.78
|
| Rate for Payer: Quartz Commercial |
$6,392.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5,900.54
|
| Rate for Payer: The Alliance Commercial |
$4,917.12
|
| Rate for Payer: WEA Trust Commercial |
$5,408.83
|
| Rate for Payer: WPS Commercial |
$7,283.96
|
|
|
ICD Check in Person
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
3052483
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.31
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
ICD Check in Person
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
3052483
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
ICD Check Remote 90 Day
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5382699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$1,004.39 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.29
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$205.14
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
ICD Check Remote 90 Day
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5382699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
ICD Check Reprogram Dual
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
3052476
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
ICD Check Reprogram Dual
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
3052476
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.15
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$339.30
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
ICD Check Reprogram Multi
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
3052477
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.11
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$330.56
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$381.42
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
ICD Check Reprogram Multi
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
3052477
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$305.14
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
ICD Check Reprogram Single
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
3052475
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
ICD Check Reprogram Single
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
3052475
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$338.52
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
ICD Gen Change Dual Lead System
|
Facility
|
OP
|
$2,526.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
4308785
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,287.25 |
| Max. Negotiated Rate |
$93,635.61 |
| Rate for Payer: Aetna Commercial |
$2,364.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,259.25
|
| Rate for Payer: Aetna Managed Medicare |
$23,408.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$23,408.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,392.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,408.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,408.90
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$2,416.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,408.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,408.90
|
| Rate for Payer: Health EOS Commercial |
$2,338.07
|
| Rate for Payer: HFN Commercial |
$2,416.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87,081.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,408.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,408.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,408.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,408.90
|
| Rate for Payer: Multiplan Commercial |
$2,101.63
|
| Rate for Payer: NAPHCARE Commercial |
$35,113.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,416.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.25
|
| Rate for Payer: Quartz Commercial |
$1,707.58
|
| Rate for Payer: Quartz Medicare Advantage |
$23,408.90
|
| Rate for Payer: The Alliance Commercial |
$93,635.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,408.90
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$1,444.87
|
| Rate for Payer: Wellcare Medicare |
$23,408.90
|
| Rate for Payer: WPS Commercial |
$1,945.78
|
|
