|
Post-Transfusion Reaction DAT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
973775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Post-Transfusion Reaction XM
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
973776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Post-Transfusion Reaction XM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
973776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Postural drainage
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989711
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Postural drainage
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989711
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Potassium, Feces
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2942896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Potassium, Feces
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
983366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: Wellcare Medicare |
$8.42
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Potassium, Feces
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
983366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Potassium, Feces
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2942896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$8.42
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Potassium, Feces
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2942896
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Potassium, Feces
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
983366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Potassium Level
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| 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 |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$7.43
|
| 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 |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Potassium Level
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Potassium Level
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
633616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$83.98 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$7.43
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
Potassium Level 24 Hour Urine
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
Potassium Level 24 Hour Urine
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: Wellcare Medicare |
$4.92
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Potassium Level 24 Hour Urine
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Potassium Level Urine
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Potassium Level Urine
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: United Healthcare PPO |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$4.92
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Potassium Level Urine
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
633617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$69.16 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$69.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$66.25
|
| Rate for Payer: HFN Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$69.16
|
| Rate for Payer: Quartz Beloit One Network |
$32.03
|
| Rate for Payer: Quartz Commercial |
$41.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
Potassium, Urine
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
5474688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
Potassium, Urine
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
5474688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: United Healthcare PPO |
$20.28
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: Wellcare Medicare |
$4.92
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
Potassium, Urine
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
5474688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$25.69 |
| Rate for Payer: Aetna Commercial |
$25.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$25.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$24.61
|
| Rate for Payer: HFN Commercial |
$25.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| Rate for Payer: Preferred Network Access Commercial |
$25.69
|
| Rate for Payer: Quartz Beloit One Network |
$11.90
|
| Rate for Payer: Quartz Commercial |
$15.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
POUCH 18403 UROSTOMY 2-1/4
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2969619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
POUCH 18403 UROSTOMY 2-1/4
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2969619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
