|
UPEP Interpretation
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2942979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$18.54
|
| Rate for Payer: Anthem Commercial |
$20.19
|
| Rate for Payer: Anthem Medicare Advantage |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.54
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.54
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.54
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$27.81
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$18.54
|
| Rate for Payer: The Alliance Commercial |
$73.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.54
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$81.59
|
|
|
U Porphyrins, Fract, Qnt / 36592
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
U Porphyrins, Fract, Qnt / 36592
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.40
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$61.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare PPO |
$92.82
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
U Porphyrins, Fract, Qnt / 36592
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$60.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$67.31
|
|
|
U-POUCH FLUID COLLECTION STERI-DRAPE 3M 1067
|
Facility
|
OP
|
$107.00
|
|
| Hospital Charge Code |
2963482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$66.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.77
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
U-POUCH FLUID COLLECTION STERI-DRAPE 3M 1067
|
Facility
|
IP
|
$107.00
|
|
| Hospital Charge Code |
2963482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
UPPER GI ENDOSCOPY, BIOPSY 43239
|
Professional
|
Both
|
$1,747.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
3014656
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.43 |
| Max. Negotiated Rate |
$1,726.04 |
| Rate for Payer: Aetna Commercial |
$1,726.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,562.52
|
| Rate for Payer: Aetna Managed Medicare |
$120.43
|
| Rate for Payer: Anthem Medicare Advantage |
$120.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.43
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cigna Commercial |
$1,726.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.43
|
| Rate for Payer: Health EOS Commercial |
$1,653.36
|
| Rate for Payer: HFN Commercial |
$1,726.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$481.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.43
|
| Rate for Payer: Multiplan Commercial |
$1,453.50
|
| Rate for Payer: NAPHCARE Commercial |
$180.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,726.04
|
| Rate for Payer: Quartz Beloit One Network |
$799.43
|
| Rate for Payer: Quartz Commercial |
$1,035.62
|
| Rate for Payer: Quartz Medicare Advantage |
$120.43
|
| Rate for Payer: The Alliance Commercial |
$511.84
|
| Rate for Payer: United Healthcare Medicaid |
$313.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$999.28
|
| Rate for Payer: WPS Commercial |
$541.94
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$45,669.52
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$13,509.63 |
| Max. Negotiated Rate |
$45,669.52 |
| Rate for Payer: Aetna Managed Medicare |
$13,509.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,046.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,396.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,978.14
|
| Rate for Payer: Anthem Medicare Advantage |
$13,509.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,509.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,509.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,509.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,948.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,509.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,253.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,509.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,509.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,509.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,509.63
|
| Rate for Payer: NAPHCARE Commercial |
$20,264.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13,509.63
|
| Rate for Payer: The Alliance Commercial |
$45,669.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,509.63
|
| Rate for Payer: United Healthcare PPO |
$25,887.98
|
| Rate for Payer: Wellcare Medicare |
$13,509.63
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$76,297.52
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$21,164.00 |
| Max. Negotiated Rate |
$76,297.52 |
| Rate for Payer: Aetna Managed Medicare |
$21,164.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58,855.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,111.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,859.31
|
| Rate for Payer: Anthem Medicare Advantage |
$21,164.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,164.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,164.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,164.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,577.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,164.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,717.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,164.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,164.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,164.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$31,746.00
|
| Rate for Payer: Quartz Medicare Advantage |
$21,164.00
|
| Rate for Payer: The Alliance Commercial |
$76,297.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,164.00
|
| Rate for Payer: United Healthcare PPO |
$43,376.61
|
| Rate for Payer: Wellcare Medicare |
$21,164.00
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$27,733.68
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$8,871.06 |
| Max. Negotiated Rate |
$27,733.68 |
| Rate for Payer: Aetna Managed Medicare |
$8,871.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,830.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,266.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,354.10
|
| Rate for Payer: Anthem Medicare Advantage |
$8,871.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,871.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,871.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,871.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,264.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,871.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,097.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,871.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,871.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,871.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,871.06
|
| Rate for Payer: NAPHCARE Commercial |
$13,306.60
|
| Rate for Payer: Quartz Medicare Advantage |
$8,871.06
|
| Rate for Payer: The Alliance Commercial |
$27,733.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,871.06
|
| Rate for Payer: United Healthcare PPO |
$15,646.14
|
| Rate for Payer: Wellcare Medicare |
$8,871.06
|
|
|
Upper limb orthosis NOS L3999
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$561.18 |
| Rate for Payer: Aetna Commercial |
$561.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$561.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.43
|
| Rate for Payer: Health EOS Commercial |
$537.56
|
| Rate for Payer: HFN Commercial |
$561.18
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: Preferred Network Access Commercial |
$561.18
|
| Rate for Payer: Quartz Beloit One Network |
$259.92
|
| Rate for Payer: Quartz Commercial |
$336.71
|
| Rate for Payer: The Alliance Commercial |
$295.36
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
Upper limb orthosis NOS L3999
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$354.43
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
Upper limb orthosis NOS L3999
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Aetna Managed Medicare |
$165.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.58
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: NAPHCARE Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$383.97
|
| Rate for Payer: Quartz Medicare Advantage |
$354.43
|
| Rate for Payer: The Alliance Commercial |
$295.36
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$1,799.99 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$72.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$154.75
|
| Rate for Payer: The Alliance Commercial |
$1,799.99
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
Upp ext fx orthosis humeral L3980
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$1,297.51 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$450.00
|
| Rate for Payer: Anthem Medicare Advantage |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$450.00
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.00
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,297.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,297.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$675.00
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$450.00
|
| Rate for Payer: The Alliance Commercial |
$1,237.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$450.00
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$787.50
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS 43235
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
3014654
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,562.03 |
| Rate for Payer: Aetna Commercial |
$1,562.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,414.05
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,562.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,496.26
|
| Rate for Payer: HFN Commercial |
$1,562.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,315.39
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,562.03
|
| Rate for Payer: Quartz Beloit One Network |
$723.47
|
| Rate for Payer: Quartz Commercial |
$937.22
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$457.74
|
| Rate for Payer: United Healthcare Medicaid |
$270.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$904.33
|
| Rate for Payer: WPS Commercial |
$484.66
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS, EXTENDED 4323522
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
CPT 43235 22
|
| Hospital Charge Code |
6175703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.82 |
| Max. Negotiated Rate |
$1,874.24 |
| Rate for Payer: Aetna Commercial |
$1,874.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,696.68
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,874.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.73
|
| Rate for Payer: Health EOS Commercial |
$1,795.32
|
| Rate for Payer: HFN Commercial |
$1,874.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.64
|
| Rate for Payer: Multiplan Commercial |
$1,578.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,874.24
|
| Rate for Payer: Quartz Beloit One Network |
$868.07
|
| Rate for Payer: Quartz Commercial |
$1,124.54
|
| Rate for Payer: The Alliance Commercial |
$986.44
|
| Rate for Payer: United Healthcare Medicaid |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$1,085.08
|
| Rate for Payer: WPS Commercial |
$1,461.26
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Urea Nitrogen 24 Hour Urine
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$25.44
|
|
|
Urea Nitrogen, PDI Fluid
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: Aetna Commercial |
$65.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$65.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$62.46
|
| Rate for Payer: HFN Commercial |
$65.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$65.21
|
| Rate for Payer: Quartz Beloit One Network |
$30.20
|
| Rate for Payer: Quartz Commercial |
$39.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$18.08
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: United Healthcare PPO |
$51.48
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: Wellcare Medicare |
$4.11
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
Urea Nitrogen Urine
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$18.08
|
|
