|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED 49618
|
Professional
|
Both
|
$9,409.00
|
|
|
Service Code
|
CPT 49618
|
| Hospital Charge Code |
6179923
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$902.70 |
| Max. Negotiated Rate |
$9,296.09 |
| Rate for Payer: Aetna Commercial |
$9,296.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,415.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,031.22
|
| Rate for Payer: Anthem Medicare Advantage |
$1,031.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,031.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,031.22
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cigna Commercial |
$9,296.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$902.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,031.22
|
| Rate for Payer: Health EOS Commercial |
$8,904.68
|
| Rate for Payer: HFN Commercial |
$9,296.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,031.22
|
| Rate for Payer: Multiplan Commercial |
$7,828.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.83
|
| Rate for Payer: Preferred Network Access Commercial |
$9,296.09
|
| Rate for Payer: Quartz Beloit One Network |
$4,305.56
|
| Rate for Payer: Quartz Commercial |
$5,577.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,031.22
|
| Rate for Payer: The Alliance Commercial |
$4,382.70
|
| Rate for Payer: United Healthcare Medicaid |
$902.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,031.22
|
| Rate for Payer: WEA Trust Commercial |
$5,381.95
|
| Rate for Payer: WPS Commercial |
$4,640.50
|
|
|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED, EXT 4961822
|
Professional
|
Both
|
$11,290.00
|
|
|
Service Code
|
CPT 49618 22
|
| Hospital Charge Code |
6181710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$902.70 |
| Max. Negotiated Rate |
$11,154.52 |
| Rate for Payer: Aetna Commercial |
$11,154.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,097.78
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cigna Commercial |
$11,154.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$902.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,044.96
|
| Rate for Payer: Health EOS Commercial |
$10,684.86
|
| Rate for Payer: HFN Commercial |
$11,154.52
|
| Rate for Payer: Multiplan Commercial |
$9,393.28
|
| Rate for Payer: Preferred Network Access Commercial |
$11,154.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,166.30
|
| Rate for Payer: Quartz Commercial |
$6,692.71
|
| Rate for Payer: The Alliance Commercial |
$5,870.80
|
| Rate for Payer: United Healthcare Medicaid |
$902.70
|
| Rate for Payer: WEA Trust Commercial |
$6,457.88
|
| Rate for Payer: WPS Commercial |
$8,696.69
|
|
|
RPR AA HERNIA RECR > 10 CM REDUCIBLE 49617
|
Professional
|
Both
|
$6,968.00
|
|
|
Service Code
|
CPT 49617
|
| Hospital Charge Code |
6179922
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$645.26 |
| Max. Negotiated Rate |
$6,884.38 |
| Rate for Payer: Aetna Commercial |
$6,884.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,232.18
|
| Rate for Payer: Aetna Managed Medicare |
$737.82
|
| Rate for Payer: Anthem Medicare Advantage |
$737.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$737.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$737.82
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,884.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$645.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$737.82
|
| Rate for Payer: Health EOS Commercial |
$6,594.52
|
| Rate for Payer: HFN Commercial |
$6,884.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$737.82
|
| Rate for Payer: Multiplan Commercial |
$5,797.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,106.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,884.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,188.56
|
| Rate for Payer: Quartz Commercial |
$4,130.63
|
| Rate for Payer: Quartz Medicare Advantage |
$737.82
|
| Rate for Payer: The Alliance Commercial |
$3,135.72
|
| Rate for Payer: United Healthcare Medicaid |
$645.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$737.82
|
| Rate for Payer: WEA Trust Commercial |
$3,985.70
|
| Rate for Payer: WPS Commercial |
$3,320.18
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED 49616
|
Professional
|
Both
|
$6,911.00
|
|
|
Service Code
|
CPT 49616
|
| Hospital Charge Code |
6179889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$624.48 |
| Max. Negotiated Rate |
$6,828.07 |
| Rate for Payer: Aetna Commercial |
$6,828.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,181.20
|
| Rate for Payer: Aetna Managed Medicare |
$713.29
|
| Rate for Payer: Anthem Medicare Advantage |
$713.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$713.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$713.29
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cigna Commercial |
$6,828.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$624.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$713.29
|
| Rate for Payer: Health EOS Commercial |
$6,540.57
|
| Rate for Payer: HFN Commercial |
$6,828.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$713.29
|
| Rate for Payer: Multiplan Commercial |
$5,749.95
|
| Rate for Payer: NAPHCARE Commercial |
$1,069.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,828.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,162.47
|
| Rate for Payer: Quartz Commercial |
$4,096.84
|
| Rate for Payer: Quartz Medicare Advantage |
$713.29
|
| Rate for Payer: The Alliance Commercial |
$3,031.50
|
| Rate for Payer: United Healthcare Medicaid |
$624.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$713.29
|
| Rate for Payer: WEA Trust Commercial |
$3,953.09
|
| Rate for Payer: WPS Commercial |
$3,209.82
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED EXTENDED 4961622
|
Professional
|
Both
|
$8,293.00
|
|
|
Service Code
|
CPT 49616 22
|
| Hospital Charge Code |
6179888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$624.48 |
| Max. Negotiated Rate |
$8,193.48 |
| Rate for Payer: Aetna Commercial |
$8,193.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,417.26
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cigna Commercial |
$8,193.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$624.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,174.83
|
| Rate for Payer: Health EOS Commercial |
$7,848.50
|
| Rate for Payer: HFN Commercial |
$8,193.48
|
| Rate for Payer: Multiplan Commercial |
$6,899.78
|
| Rate for Payer: Preferred Network Access Commercial |
$8,193.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,794.88
|
| Rate for Payer: Quartz Commercial |
$4,916.09
|
| Rate for Payer: The Alliance Commercial |
$4,312.36
|
| Rate for Payer: United Healthcare Medicaid |
$624.48
|
| Rate for Payer: WEA Trust Commercial |
$4,743.60
|
| Rate for Payer: WPS Commercial |
$6,388.10
|
|
|
RPR AA HERNIA RECR 3-10 CM REDUCIBLE 49615
|
Professional
|
Both
|
$5,368.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
6179921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$465.62 |
| Max. Negotiated Rate |
$5,303.58 |
| Rate for Payer: Aetna Commercial |
$5,303.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,801.14
|
| Rate for Payer: Aetna Managed Medicare |
$532.29
|
| Rate for Payer: Anthem Medicare Advantage |
$532.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$532.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$532.29
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cigna Commercial |
$5,303.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$465.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.29
|
| Rate for Payer: Health EOS Commercial |
$5,080.28
|
| Rate for Payer: HFN Commercial |
$5,303.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$532.29
|
| Rate for Payer: Multiplan Commercial |
$4,466.18
|
| Rate for Payer: NAPHCARE Commercial |
$798.44
|
| Rate for Payer: Preferred Network Access Commercial |
$5,303.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,456.40
|
| Rate for Payer: Quartz Commercial |
$3,182.15
|
| Rate for Payer: Quartz Medicare Advantage |
$532.29
|
| Rate for Payer: The Alliance Commercial |
$2,262.24
|
| Rate for Payer: United Healthcare Medicaid |
$465.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$532.29
|
| Rate for Payer: WEA Trust Commercial |
$3,070.50
|
| Rate for Payer: WPS Commercial |
$2,395.32
|
|
|
RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED 49614
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
6179920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.16 |
| Max. Negotiated Rate |
$3,848.26 |
| Rate for Payer: Aetna Commercial |
$3,848.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,483.69
|
| Rate for Payer: Aetna Managed Medicare |
$477.78
|
| Rate for Payer: Anthem Medicare Advantage |
$477.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$477.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$477.78
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$3,848.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$416.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.78
|
| Rate for Payer: Health EOS Commercial |
$3,686.23
|
| Rate for Payer: HFN Commercial |
$3,848.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$477.78
|
| Rate for Payer: Multiplan Commercial |
$3,240.64
|
| Rate for Payer: NAPHCARE Commercial |
$716.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,848.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,782.35
|
| Rate for Payer: Quartz Commercial |
$2,308.96
|
| Rate for Payer: Quartz Medicare Advantage |
$477.78
|
| Rate for Payer: The Alliance Commercial |
$2,030.55
|
| Rate for Payer: United Healthcare Medicaid |
$416.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$477.78
|
| Rate for Payer: WEA Trust Commercial |
$2,227.94
|
| Rate for Payer: WPS Commercial |
$2,149.99
|
|
|
RPR AA HERNIA RECR < 3 CM REDUCIBLE 49613
|
Professional
|
Both
|
$3,743.00
|
|
|
Service Code
|
CPT 49613
|
| Hospital Charge Code |
6179919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.70 |
| Max. Negotiated Rate |
$3,698.08 |
| Rate for Payer: Aetna Commercial |
$3,698.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,347.74
|
| Rate for Payer: Aetna Managed Medicare |
$354.24
|
| Rate for Payer: Anthem Medicare Advantage |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$354.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$354.24
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cigna Commercial |
$3,698.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.24
|
| Rate for Payer: Health EOS Commercial |
$3,542.38
|
| Rate for Payer: HFN Commercial |
$3,698.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$354.24
|
| Rate for Payer: Multiplan Commercial |
$3,114.18
|
| Rate for Payer: NAPHCARE Commercial |
$531.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,698.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,712.80
|
| Rate for Payer: Quartz Commercial |
$2,218.85
|
| Rate for Payer: Quartz Medicare Advantage |
$354.24
|
| Rate for Payer: The Alliance Commercial |
$1,505.54
|
| Rate for Payer: United Healthcare Medicaid |
$307.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$354.24
|
| Rate for Payer: WEA Trust Commercial |
$2,141.00
|
| Rate for Payer: WPS Commercial |
$1,594.10
|
|
|
RPR AARPR AA HERNIA RECR > 10 CM REDUCIBLE, EXT 4961722
|
Professional
|
Both
|
$8,362.00
|
|
|
Service Code
|
CPT 49617 22
|
| Hospital Charge Code |
6186963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$645.26 |
| Max. Negotiated Rate |
$8,261.66 |
| Rate for Payer: Aetna Commercial |
$8,261.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,478.97
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cigna Commercial |
$8,261.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$645.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,217.89
|
| Rate for Payer: Health EOS Commercial |
$7,913.80
|
| Rate for Payer: HFN Commercial |
$8,261.66
|
| Rate for Payer: Multiplan Commercial |
$6,957.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,261.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,826.45
|
| Rate for Payer: Quartz Commercial |
$4,956.99
|
| Rate for Payer: The Alliance Commercial |
$4,348.24
|
| Rate for Payer: United Healthcare Medicaid |
$645.26
|
| Rate for Payer: WEA Trust Commercial |
$4,783.06
|
| Rate for Payer: WPS Commercial |
$6,441.25
|
|
|
RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL 67901
|
Professional
|
Both
|
$4,420.00
|
|
|
Service Code
|
CPT 67901
|
| Hospital Charge Code |
6242599
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$497.30 |
| Max. Negotiated Rate |
$4,366.96 |
| Rate for Payer: Aetna Commercial |
$4,366.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.25
|
| Rate for Payer: Aetna Managed Medicare |
$497.30
|
| Rate for Payer: Anthem Medicare Advantage |
$497.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$497.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$497.30
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$4,366.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$925.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.30
|
| Rate for Payer: Health EOS Commercial |
$4,183.09
|
| Rate for Payer: HFN Commercial |
$4,366.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,055.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$497.30
|
| Rate for Payer: Multiplan Commercial |
$3,677.44
|
| Rate for Payer: NAPHCARE Commercial |
$745.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,366.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,022.59
|
| Rate for Payer: Quartz Commercial |
$2,620.18
|
| Rate for Payer: Quartz Medicare Advantage |
$497.30
|
| Rate for Payer: The Alliance Commercial |
$2,113.51
|
| Rate for Payer: United Healthcare Medicaid |
$925.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$497.30
|
| Rate for Payer: WEA Trust Commercial |
$2,528.24
|
| Rate for Payer: WPS Commercial |
$2,237.84
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 67908
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
CPT 67908
|
| Hospital Charge Code |
5102674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$371.77 |
| Max. Negotiated Rate |
$3,176.42 |
| Rate for Payer: Aetna Commercial |
$3,176.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.50
|
| Rate for Payer: Aetna Managed Medicare |
$371.77
|
| Rate for Payer: Anthem Medicare Advantage |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$371.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$371.77
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,176.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$705.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.77
|
| Rate for Payer: Health EOS Commercial |
$3,042.68
|
| Rate for Payer: HFN Commercial |
$3,176.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,508.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,508.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$371.77
|
| Rate for Payer: Multiplan Commercial |
$2,674.88
|
| Rate for Payer: NAPHCARE Commercial |
$557.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,176.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,471.18
|
| Rate for Payer: Quartz Commercial |
$1,905.85
|
| Rate for Payer: Quartz Medicare Advantage |
$371.77
|
| Rate for Payer: The Alliance Commercial |
$1,580.02
|
| Rate for Payer: United Healthcare Medicaid |
$705.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.77
|
| Rate for Payer: WEA Trust Commercial |
$1,838.98
|
| Rate for Payer: WPS Commercial |
$1,672.96
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 6790850
|
Professional
|
Both
|
$6,430.00
|
|
|
Service Code
|
CPT 67908 50
|
| Hospital Charge Code |
5102675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$705.09 |
| Max. Negotiated Rate |
$6,352.84 |
| Rate for Payer: Aetna Commercial |
$6,352.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,750.99
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$6,352.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$705.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,012.32
|
| Rate for Payer: Health EOS Commercial |
$6,085.35
|
| Rate for Payer: HFN Commercial |
$6,352.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,508.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,508.17
|
| Rate for Payer: Multiplan Commercial |
$5,349.76
|
| Rate for Payer: Preferred Network Access Commercial |
$6,352.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,942.37
|
| Rate for Payer: Quartz Commercial |
$3,811.70
|
| Rate for Payer: The Alliance Commercial |
$3,343.60
|
| Rate for Payer: United Healthcare Medicaid |
$705.09
|
| Rate for Payer: WEA Trust Commercial |
$3,677.96
|
| Rate for Payer: WPS Commercial |
$4,953.03
|
|
|
RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
6242814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.44 |
| Max. Negotiated Rate |
$1,359.49 |
| Rate for Payer: Aetna Commercial |
$1,359.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Aetna Managed Medicare |
$161.44
|
| Rate for Payer: Anthem Medicare Advantage |
$161.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.44
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,359.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.44
|
| Rate for Payer: Health EOS Commercial |
$1,302.25
|
| Rate for Payer: HFN Commercial |
$1,359.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.44
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: NAPHCARE Commercial |
$242.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.49
|
| Rate for Payer: Quartz Beloit One Network |
$629.66
|
| Rate for Payer: Quartz Commercial |
$815.69
|
| Rate for Payer: Quartz Medicare Advantage |
$161.44
|
| Rate for Payer: The Alliance Commercial |
$686.12
|
| Rate for Payer: United Healthcare Medicaid |
$426.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.44
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$726.48
|
|
|
RPR NSL VLV COLLAPSE LW NRG SUBQ/SBMCSL RMDLG 30469
|
Professional
|
Both
|
$9,812.00
|
|
|
Service Code
|
CPT 30469
|
| Hospital Charge Code |
6243937
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$9,694.26 |
| Rate for Payer: Aetna Commercial |
$9,694.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,775.85
|
| Rate for Payer: Aetna Managed Medicare |
$124.47
|
| Rate for Payer: Anthem Medicare Advantage |
$124.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.47
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cigna Commercial |
$9,694.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,102.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.47
|
| Rate for Payer: Health EOS Commercial |
$9,286.08
|
| Rate for Payer: HFN Commercial |
$9,694.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.47
|
| Rate for Payer: Multiplan Commercial |
$8,163.58
|
| Rate for Payer: NAPHCARE Commercial |
$186.70
|
| Rate for Payer: Preferred Network Access Commercial |
$9,694.26
|
| Rate for Payer: Quartz Beloit One Network |
$4,489.97
|
| Rate for Payer: Quartz Commercial |
$5,816.55
|
| Rate for Payer: Quartz Medicare Advantage |
$124.47
|
| Rate for Payer: The Alliance Commercial |
$528.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.47
|
| Rate for Payer: WEA Trust Commercial |
$5,612.46
|
| Rate for Payer: WPS Commercial |
$560.10
|
|
|
RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT - 30468
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
CPT 30468
|
| Hospital Charge Code |
5923671
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$3,778.11 |
| Rate for Payer: Aetna Commercial |
$3,778.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,420.19
|
| Rate for Payer: Aetna Managed Medicare |
$140.05
|
| Rate for Payer: Anthem Medicare Advantage |
$140.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.05
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cigna Commercial |
$3,778.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,988.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.05
|
| Rate for Payer: Health EOS Commercial |
$3,619.03
|
| Rate for Payer: HFN Commercial |
$3,778.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$577.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$577.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.05
|
| Rate for Payer: Multiplan Commercial |
$3,181.57
|
| Rate for Payer: NAPHCARE Commercial |
$210.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,778.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.86
|
| Rate for Payer: Quartz Commercial |
$2,266.87
|
| Rate for Payer: Quartz Medicare Advantage |
$140.05
|
| Rate for Payer: The Alliance Commercial |
$595.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.05
|
| Rate for Payer: WEA Trust Commercial |
$2,187.33
|
| Rate for Payer: WPS Commercial |
$630.21
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE 49621
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621
|
| Hospital Charge Code |
6180266
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$545.34 |
| Max. Negotiated Rate |
$7,500.90 |
| Rate for Payer: Aetna Commercial |
$7,500.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,790.28
|
| Rate for Payer: Aetna Managed Medicare |
$629.01
|
| Rate for Payer: Anthem Medicare Advantage |
$629.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$629.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$629.01
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,500.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$545.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.01
|
| Rate for Payer: Health EOS Commercial |
$7,185.07
|
| Rate for Payer: HFN Commercial |
$7,500.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$629.01
|
| Rate for Payer: Multiplan Commercial |
$6,316.54
|
| Rate for Payer: NAPHCARE Commercial |
$943.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,500.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,474.10
|
| Rate for Payer: Quartz Commercial |
$4,500.54
|
| Rate for Payer: Quartz Medicare Advantage |
$629.01
|
| Rate for Payer: The Alliance Commercial |
$2,673.30
|
| Rate for Payer: United Healthcare Medicaid |
$545.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$629.01
|
| Rate for Payer: WEA Trust Commercial |
$4,342.62
|
| Rate for Payer: WPS Commercial |
$2,830.56
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE, EXT 4962122
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621 22
|
| Hospital Charge Code |
6180267
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$545.34 |
| Max. Negotiated Rate |
$7,500.90 |
| Rate for Payer: Aetna Commercial |
$7,500.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,790.28
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,500.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$545.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,737.41
|
| Rate for Payer: Health EOS Commercial |
$7,185.07
|
| Rate for Payer: HFN Commercial |
$7,500.90
|
| Rate for Payer: Multiplan Commercial |
$6,316.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,500.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,474.10
|
| Rate for Payer: Quartz Commercial |
$4,500.54
|
| Rate for Payer: The Alliance Commercial |
$3,947.84
|
| Rate for Payer: United Healthcare Medicaid |
$545.34
|
| Rate for Payer: WEA Trust Commercial |
$4,342.62
|
| Rate for Payer: WPS Commercial |
$5,848.12
|
|
|
RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED 49622
|
Professional
|
Both
|
$9,464.00
|
|
|
Service Code
|
CPT 49622
|
| Hospital Charge Code |
6180268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$673.17 |
| Max. Negotiated Rate |
$9,350.43 |
| Rate for Payer: Aetna Commercial |
$9,350.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,464.60
|
| Rate for Payer: Aetna Managed Medicare |
$778.28
|
| Rate for Payer: Anthem Medicare Advantage |
$778.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$778.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$778.28
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cigna Commercial |
$9,350.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$673.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.28
|
| Rate for Payer: Health EOS Commercial |
$8,956.73
|
| Rate for Payer: HFN Commercial |
$9,350.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$778.28
|
| Rate for Payer: Multiplan Commercial |
$7,874.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.43
|
| Rate for Payer: Preferred Network Access Commercial |
$9,350.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,330.73
|
| Rate for Payer: Quartz Commercial |
$5,610.26
|
| Rate for Payer: Quartz Medicare Advantage |
$778.28
|
| Rate for Payer: The Alliance Commercial |
$3,307.71
|
| Rate for Payer: United Healthcare Medicaid |
$673.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$778.28
|
| Rate for Payer: WEA Trust Commercial |
$5,413.41
|
| Rate for Payer: WPS Commercial |
$3,502.28
|
|
|
.RPR Titer
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
.RPR Titer
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$4.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.60
|
| Rate for Payer: Anthem Medicare Advantage |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.58
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$6.86
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.58
|
| Rate for Payer: The Alliance Commercial |
$18.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.58
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$4.58
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
.RPR Titer
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$4.58
|
| Rate for Payer: Anthem Medicare Advantage |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.58
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$6.86
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4.58
|
| Rate for Payer: The Alliance Commercial |
$18.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.58
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$20.13
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
RSV IG, IM, 50MG 90378
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$454.22 |
| Max. Negotiated Rate |
$2,816.82 |
| Rate for Payer: Aetna Commercial |
$2,755.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Aetna Managed Medicare |
$454.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,469.64
|
| Rate for Payer: Anthem Medicare Advantage |
$454.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$454.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$454.22
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,816.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$454.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$454.22
|
| Rate for Payer: Health EOS Commercial |
$2,724.97
|
| Rate for Payer: HFN Commercial |
$2,816.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,689.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$454.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$454.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$454.22
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: NAPHCARE Commercial |
$681.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,816.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.26
|
| Rate for Payer: Quartz Commercial |
$1,990.14
|
| Rate for Payer: Quartz Medicare Advantage |
$454.22
|
| Rate for Payer: The Alliance Commercial |
$1,816.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$454.22
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: Wellcare Medicare |
$454.22
|
| Rate for Payer: WPS Commercial |
$2,267.76
|
|
