|
Layer closure of wounds (scalp, axillae, trunk, extremities) 7.6-12.5cm 12034
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
3013594
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.52 |
| Max. Negotiated Rate |
$682.45 |
| Rate for Payer: Aetna Commercial |
$450.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.64
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cigna Commercial |
$450.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.40
|
| Rate for Payer: Health EOS Commercial |
$431.34
|
| Rate for Payer: HFN Commercial |
$450.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$682.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$682.45
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Preferred Network Access Commercial |
$450.30
|
| Rate for Payer: Quartz Beloit One Network |
$208.56
|
| Rate for Payer: Quartz Commercial |
$270.18
|
| Rate for Payer: The Alliance Commercial |
$237.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.52
|
| Rate for Payer: WEA Trust Commercial |
$260.70
|
| Rate for Payer: WPS Commercial |
$351.09
|
|
|
lbandronate sodium injection 1 mg J1740
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
3761591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Aetna Managed Medicare |
$124.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$288.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.32
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$408.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.96
|
| Rate for Payer: Health EOS Commercial |
$395.16
|
| Rate for Payer: HFN Commercial |
$408.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.00
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: NAPHCARE Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$408.48
|
| Rate for Payer: Quartz Beloit One Network |
$217.56
|
| Rate for Payer: Quartz Commercial |
$288.60
|
| Rate for Payer: Quartz Medicare Advantage |
$266.40
|
| Rate for Payer: The Alliance Commercial |
$1,776.00
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$79.28
|
|
|
lbandronate sodium injection 1 mg J1740
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
3761591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$408.48 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.32
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$408.48
|
| Rate for Payer: Health EOS Commercial |
$395.16
|
| Rate for Payer: HFN Commercial |
$408.48
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: NAPHCARE Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$408.48
|
| Rate for Payer: Quartz Beloit One Network |
$217.56
|
| Rate for Payer: Quartz Commercial |
$266.40
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$328.87
|
|
|
lbandronate sodium injection 1 mg J1740
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
3761591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Aetna Commercial |
$421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$421.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.71
|
| Rate for Payer: Health EOS Commercial |
$404.04
|
| Rate for Payer: HFN Commercial |
$421.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.28
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$421.80
|
| Rate for Payer: Quartz Beloit One Network |
$195.36
|
| Rate for Payer: Quartz Commercial |
$253.08
|
| Rate for Payer: The Alliance Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicaid |
$25.60
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$79.28
|
|
|
LD, CSF to Mayo
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3587539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
LD, CSF to Mayo
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3587539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
LD, CSF to Mayo
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3587539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: HFN Commercial |
$82.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
LDL Direct
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$10.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.43
|
| Rate for Payer: Anthem Medicaid |
$10.85
|
| Rate for Payer: Anthem Medicare Advantage |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.50
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Dean Health Medicaid |
$10.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.50
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.50
|
| Rate for Payer: Managed Health Services Medicaid |
$11.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.75
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.85
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$10.50
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.50
|
| Rate for Payer: United Healthcare PPO |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: Wellcare Medicare |
$10.50
|
| Rate for Payer: WMAP Medicaid |
$10.85
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
LDL Direct
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
LDL Direct
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$247.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.60
|
| Rate for Payer: Health EOS Commercial |
$237.51
|
| Rate for Payer: HFN Commercial |
$247.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.07
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$247.95
|
| Rate for Payer: Quartz Beloit One Network |
$114.84
|
| Rate for Payer: Quartz Commercial |
$148.77
|
| Rate for Payer: The Alliance Commercial |
$130.50
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
LDL Particle Number
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$136.76 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$34.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.76
|
| Rate for Payer: Anthem Medicaid |
$35.33
|
| Rate for Payer: Anthem Medicare Advantage |
$34.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.19
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Dean Health Medicaid |
$35.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34.19
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.19
|
| Rate for Payer: Managed Health Services Medicaid |
$36.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34.19
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.28
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.33
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$34.19
|
| Rate for Payer: The Alliance Commercial |
$136.76
|
| Rate for Payer: United Healthcare Medicaid |
$35.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.19
|
| Rate for Payer: United Healthcare PPO |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$34.19
|
| Rate for Payer: WMAP Medicaid |
$35.33
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
LDL Particle Number
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$120.69 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: HFN Commercial |
$104.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.69
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: The Alliance Commercial |
$55.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
LDL Particle Number
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
LD, Pericardial Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.64
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Pericardial Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.80
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: HFN Commercial |
$97.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$51.50
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Pericardial Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Peritoneal Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.64
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Peritoneal Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Peritoneal Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.80
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: HFN Commercial |
$97.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$51.50
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Pleural Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.80
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: HFN Commercial |
$97.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$51.50
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Pleural Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.64
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Pleural Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Synovial Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.03
|
| Rate for Payer: Anthem Medicaid |
$6.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.04
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.64
|
| Rate for Payer: Dean Health Medicaid |
$6.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.04
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.04
|
| Rate for Payer: Managed Health Services Medicaid |
$6.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.06
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.24
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.04
|
| Rate for Payer: The Alliance Commercial |
$24.16
|
| Rate for Payer: United Healthcare Medicaid |
$6.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$6.04
|
| Rate for Payer: WMAP Medicaid |
$6.24
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Synovial Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.80
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: HFN Commercial |
$97.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.32
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$51.50
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
LD, Synovial Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
