|
Bilateral - Ear, impacted cerumen removal
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$181,597.00
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$65,322.60 |
| Max. Negotiated Rate |
$181,597.00 |
| Rate for Payer: Aetna Managed Medicare |
$65,322.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143,083.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109,672.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104,195.96
|
| Rate for Payer: Anthem Medicare Advantage |
$65,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65,322.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65,322.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65,322.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115,667.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65,322.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132,960.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65,322.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65,322.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65,322.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65,322.60
|
| Rate for Payer: NAPHCARE Commercial |
$97,983.90
|
| Rate for Payer: Quartz Medicare Advantage |
$65,322.60
|
| Rate for Payer: The Alliance Commercial |
$181,597.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65,322.60
|
| Rate for Payer: United Healthcare PPO |
$103,511.65
|
| Rate for Payer: Wellcare Medicare |
$65,322.60
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$75,992.00
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$27,335.27 |
| Max. Negotiated Rate |
$75,992.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,335.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,793.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,830.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,542.30
|
| Rate for Payer: Anthem Medicare Advantage |
$27,335.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,335.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,335.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,335.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,335.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,335.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,502.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,335.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,335.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,335.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,335.27
|
| Rate for Payer: NAPHCARE Commercial |
$41,002.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27,335.27
|
| Rate for Payer: The Alliance Commercial |
$75,992.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,335.27
|
| Rate for Payer: United Healthcare PPO |
$43,209.68
|
| Rate for Payer: Wellcare Medicare |
$27,335.27
|
|
|
Bile Acids, Fractionated and Total
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Bile Acids, Fractionated and Total
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Bile Acids, Fractionated and Total
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$85.04 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.00
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: HFN Commercial |
$80.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$42.50
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Bile Acids, Fractionated and Total, Pregnancy
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1124804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.11
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Bile Acids, Fractionated and Total, Pregnancy
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1124804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$24.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.02
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.11
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicaid |
$24.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.11
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.11
|
| Rate for Payer: Managed Health Services Medicaid |
$25.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$36.16
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.91
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$24.11
|
| Rate for Payer: The Alliance Commercial |
$96.44
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$24.11
|
| Rate for Payer: WMAP Medicaid |
$24.91
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Bile Acids, Fractionated and Total, Pregnancy
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1124804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
BILIARY BYPASS GRAFT
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2959842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
BILIARY BYPASS GRAFT
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2959842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$52,357.00
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$18,833.51 |
| Max. Negotiated Rate |
$52,357.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,833.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,120.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,518.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,944.88
|
| Rate for Payer: Anthem Medicare Advantage |
$18,833.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,833.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,833.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,833.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,241.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,833.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,167.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,833.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,833.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,833.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,833.51
|
| Rate for Payer: NAPHCARE Commercial |
$28,250.26
|
| Rate for Payer: Quartz Medicare Advantage |
$18,833.51
|
| Rate for Payer: The Alliance Commercial |
$52,357.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,833.51
|
| Rate for Payer: United Healthcare PPO |
$29,713.77
|
| Rate for Payer: Wellcare Medicare |
$18,833.51
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$99,279.00
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$35,711.77 |
| Max. Negotiated Rate |
$99,279.00 |
| Rate for Payer: Aetna Managed Medicare |
$35,711.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78,045.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,821.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,834.16
|
| Rate for Payer: Anthem Medicare Advantage |
$35,711.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,711.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,711.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,711.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,091.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,711.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72,582.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,711.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,711.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,711.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,711.77
|
| Rate for Payer: NAPHCARE Commercial |
$53,567.66
|
| Rate for Payer: Quartz Medicare Advantage |
$35,711.77
|
| Rate for Payer: The Alliance Commercial |
$99,279.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,711.77
|
| Rate for Payer: United Healthcare PPO |
$56,506.72
|
| Rate for Payer: Wellcare Medicare |
$35,711.77
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$41,933.00
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$15,083.73 |
| Max. Negotiated Rate |
$41,933.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,083.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,938.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,247.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,986.46
|
| Rate for Payer: Anthem Medicare Advantage |
$15,083.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,083.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,083.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,083.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,627.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,083.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,521.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,083.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,083.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,083.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,083.73
|
| Rate for Payer: NAPHCARE Commercial |
$22,625.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,083.73
|
| Rate for Payer: The Alliance Commercial |
$41,933.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,083.73
|
| Rate for Payer: United Healthcare PPO |
$23,761.30
|
| Rate for Payer: Wellcare Medicare |
$15,083.73
|
|
|
Bil Inj Paravertebral Facet 6449350
|
Professional
|
Both
|
$2,245.00
|
|
|
Service Code
|
CPT 64493 50
|
| Hospital Charge Code |
3165618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.05 |
| Max. Negotiated Rate |
$2,132.75 |
| Rate for Payer: Aetna Commercial |
$2,132.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,930.70
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,132.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,347.00
|
| Rate for Payer: Health EOS Commercial |
$2,042.95
|
| Rate for Payer: HFN Commercial |
$2,132.75
|
| Rate for Payer: Multiplan Commercial |
$1,796.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.75
|
| Rate for Payer: Quartz Beloit One Network |
$987.80
|
| Rate for Payer: Quartz Commercial |
$1,279.65
|
| Rate for Payer: The Alliance Commercial |
$1,122.50
|
| Rate for Payer: United Healthcare Medicaid |
$124.05
|
| Rate for Payer: WEA Trust Commercial |
$1,234.75
|
| Rate for Payer: WPS Commercial |
$1,662.87
|
|
|
Bil Inj Paravertebral Facet 6449450
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
CPT 64494 50
|
| Hospital Charge Code |
3165637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$1,307.20 |
| Rate for Payer: Aetna Commercial |
$1,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,307.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$825.60
|
| Rate for Payer: Health EOS Commercial |
$1,252.16
|
| Rate for Payer: HFN Commercial |
$1,307.20
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.20
|
| Rate for Payer: Quartz Beloit One Network |
$605.44
|
| Rate for Payer: Quartz Commercial |
$784.32
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.80
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
Bilirubin, Body Fluid
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.33
|
| Rate for Payer: Anthem Medicaid |
$4.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Dean Health Medicaid |
$4.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Managed Health Services Medicaid |
$4.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.24
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$20.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare PPO |
$99.75
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.24
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Bilirubin, Body Fluid
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Bilirubin Direct
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
981837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Direct
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
981837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.72
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Direct
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.72
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Direct
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
981837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.33
|
| Rate for Payer: Anthem Medicaid |
$4.70
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$4.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Managed Health Services Medicaid |
$4.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.70
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$20.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.70
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Direct
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.33
|
| Rate for Payer: Anthem Medicaid |
$4.70
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$4.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Managed Health Services Medicaid |
$4.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.70
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$20.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.70
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Direct
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Bilirubin Neonatal
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.33
|
| Rate for Payer: Anthem Medicaid |
$4.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$4.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Managed Health Services Medicaid |
$4.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.24
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$20.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.24
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
