|
Leflunomide Level
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5096621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
Leflunomide Level
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5096621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Leflunomide Level
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5096621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
LEFT CATH INC INTRA INJ LEFT VEN, CAT BY GRAFT 93459
|
Professional
|
Both
|
$6,029.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
3015399
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$866.88 |
| Max. Negotiated Rate |
$5,956.65 |
| Rate for Payer: Aetna Commercial |
$5,956.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,392.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,063.43
|
| Rate for Payer: Anthem Medicare Advantage |
$1,063.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,063.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,063.43
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cigna Commercial |
$5,956.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$866.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.43
|
| Rate for Payer: Health EOS Commercial |
$5,705.85
|
| Rate for Payer: HFN Commercial |
$5,956.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,194.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,194.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,063.43
|
| Rate for Payer: Multiplan Commercial |
$5,016.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,595.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.87
|
| Rate for Payer: Quartz Commercial |
$3,573.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,063.43
|
| Rate for Payer: The Alliance Commercial |
$4,041.04
|
| Rate for Payer: United Healthcare Medicaid |
$866.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,063.43
|
| Rate for Payer: WEA Trust Commercial |
$3,448.59
|
| Rate for Payer: WPS Commercial |
$4,253.72
|
|
|
LEFT CATH INC INTRA INJ LEFT VEN, CAT BY GRAFT 9345926
|
Professional
|
Both
|
$6,029.00
|
|
|
Service Code
|
CPT 93459 26
|
| Hospital Charge Code |
3015400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$257.30 |
| Max. Negotiated Rate |
$5,956.65 |
| Rate for Payer: Aetna Commercial |
$5,956.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,392.34
|
| Rate for Payer: Aetna Managed Medicare |
$306.05
|
| Rate for Payer: Anthem Medicare Advantage |
$306.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$306.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$306.05
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cash Price |
$1,808.70
|
| Rate for Payer: Cigna Commercial |
$5,956.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.05
|
| Rate for Payer: Health EOS Commercial |
$5,705.85
|
| Rate for Payer: HFN Commercial |
$5,956.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,124.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$306.05
|
| Rate for Payer: Multiplan Commercial |
$5,016.13
|
| Rate for Payer: NAPHCARE Commercial |
$459.08
|
| Rate for Payer: Preferred Network Access Commercial |
$5,956.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,758.87
|
| Rate for Payer: Quartz Commercial |
$3,573.99
|
| Rate for Payer: Quartz Medicare Advantage |
$306.05
|
| Rate for Payer: The Alliance Commercial |
$1,162.99
|
| Rate for Payer: United Healthcare Medicaid |
$257.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.05
|
| Rate for Payer: WEA Trust Commercial |
$3,448.59
|
| Rate for Payer: WPS Commercial |
$1,224.20
|
|
|
Left - Ear, impacted cerumen removal
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Left - Ear, impacted cerumen removal
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
LEFT HT CATH INC INTRA INJ LEFT VEN 93458
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
3015397
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$4,717.70 |
| Rate for Payer: Aetna Commercial |
$4,717.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,270.76
|
| Rate for Payer: Aetna Managed Medicare |
$988.78
|
| Rate for Payer: Anthem Medicare Advantage |
$988.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$988.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$988.78
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cigna Commercial |
$4,717.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$784.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.78
|
| Rate for Payer: Health EOS Commercial |
$4,519.06
|
| Rate for Payer: HFN Commercial |
$4,717.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,883.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,883.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$988.78
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.17
|
| Rate for Payer: Preferred Network Access Commercial |
$4,717.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.04
|
| Rate for Payer: Quartz Commercial |
$2,830.62
|
| Rate for Payer: Quartz Medicare Advantage |
$988.78
|
| Rate for Payer: The Alliance Commercial |
$3,757.36
|
| Rate for Payer: United Healthcare Medicaid |
$784.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$988.78
|
| Rate for Payer: WEA Trust Commercial |
$2,731.30
|
| Rate for Payer: WPS Commercial |
$3,955.12
|
|
|
LEFT HT CATH INC INTRA INJ LEFT VEN 9345822
|
Professional
|
Both
|
$5,729.00
|
|
|
Service Code
|
CPT 93458 22
|
| Hospital Charge Code |
5190613
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$784.80 |
| Max. Negotiated Rate |
$5,660.25 |
| Rate for Payer: Aetna Commercial |
$5,660.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,124.02
|
| Rate for Payer: Cash Price |
$1,718.70
|
| Rate for Payer: Cash Price |
$1,718.70
|
| Rate for Payer: Cash Price |
$1,718.70
|
| Rate for Payer: Cigna Commercial |
$5,660.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$784.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,574.90
|
| Rate for Payer: Health EOS Commercial |
$5,421.93
|
| Rate for Payer: HFN Commercial |
$5,660.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,883.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,883.29
|
| Rate for Payer: Multiplan Commercial |
$4,766.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,660.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,621.59
|
| Rate for Payer: Quartz Commercial |
$3,396.15
|
| Rate for Payer: The Alliance Commercial |
$2,979.08
|
| Rate for Payer: United Healthcare Medicaid |
$784.80
|
| Rate for Payer: WEA Trust Commercial |
$3,276.99
|
| Rate for Payer: WPS Commercial |
$4,413.05
|
|
|
LEFT HT CATH INC INTRA INJ LEFT VEN 9345826
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
CPT 93458 26
|
| Hospital Charge Code |
3015398
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$4,717.70 |
| Rate for Payer: Aetna Commercial |
$4,717.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,270.76
|
| Rate for Payer: Aetna Managed Medicare |
$269.78
|
| Rate for Payer: Anthem Medicare Advantage |
$269.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$269.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$269.78
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cigna Commercial |
$4,717.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.78
|
| Rate for Payer: Health EOS Commercial |
$4,519.06
|
| Rate for Payer: HFN Commercial |
$4,717.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$269.78
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$404.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,717.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.04
|
| Rate for Payer: Quartz Commercial |
$2,830.62
|
| Rate for Payer: Quartz Medicare Advantage |
$269.78
|
| Rate for Payer: The Alliance Commercial |
$1,025.15
|
| Rate for Payer: United Healthcare Medicaid |
$228.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$269.78
|
| Rate for Payer: WEA Trust Commercial |
$2,731.30
|
| Rate for Payer: WPS Commercial |
$1,079.10
|
|
|
Legal Blood Draw
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
4254040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Legal Blood Draw
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
4254040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$44.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$42.59
|
| Rate for Payer: HFN Commercial |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$44.46
|
| Rate for Payer: Quartz Beloit One Network |
$20.59
|
| Rate for Payer: Quartz Commercial |
$26.68
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$41.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$42.74
|
|
|
Legal Blood Draw
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
4254040
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$38.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare PPO |
$35.10
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: Wellcare Medicare |
$9.71
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
LEG, EXTERNAL FIXATOR
|
Facility
|
OP
|
$5,199.00
|
|
| Hospital Charge Code |
2960040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,513.95 |
| Max. Negotiated Rate |
$4,974.40 |
| Rate for Payer: Aetna Commercial |
$4,866.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,649.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,513.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,514.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,703.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,595.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,865.69
|
| Rate for Payer: Cash Price |
$1,559.70
|
| Rate for Payer: Cigna Commercial |
$4,974.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,025.82
|
| Rate for Payer: Health EOS Commercial |
$4,812.19
|
| Rate for Payer: HFN Commercial |
$4,974.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,055.22
|
| Rate for Payer: Multiplan Commercial |
$4,325.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,244.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,649.41
|
| Rate for Payer: Quartz Commercial |
$3,514.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,244.18
|
| Rate for Payer: The Alliance Commercial |
$2,703.48
|
| Rate for Payer: WEA Trust Commercial |
$2,973.83
|
| Rate for Payer: WPS Commercial |
$4,004.79
|
|
|
LEG, EXTERNAL FIXATOR
|
Facility
|
IP
|
$5,199.00
|
|
| Hospital Charge Code |
2960040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,649.41 |
| Max. Negotiated Rate |
$4,974.40 |
| Rate for Payer: Aetna Commercial |
$4,866.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,649.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,865.69
|
| Rate for Payer: Cash Price |
$1,559.70
|
| Rate for Payer: Cigna Commercial |
$4,974.40
|
| Rate for Payer: Health EOS Commercial |
$4,812.19
|
| Rate for Payer: HFN Commercial |
$4,974.40
|
| Rate for Payer: Multiplan Commercial |
$4,325.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,974.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,649.41
|
| Rate for Payer: Quartz Commercial |
$3,244.18
|
| Rate for Payer: WEA Trust Commercial |
$2,973.83
|
| Rate for Payer: WPS Commercial |
$4,004.79
|
|
|
LEG FASCIOTOMY, LOWER
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950481
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LEG FASCIOTOMY, LOWER
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950481
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
LEGGINGS 89408
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2963429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
LEGGINGS 89408
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2963429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Legionella Antigen Urine
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$127.14
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Legionella Antigen Urine
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Legionella Antigen Urine
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Legionella Culture / 688
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: United Healthcare PPO |
$49.14
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: Wellcare Medicare |
$6.90
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
Legionella Culture / 688
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$30.34
|
|
|
Legionella Culture / 688
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
