|
Bilirubin Neonatal
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| 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 |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin Neonatal
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin Neonatal
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| 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 |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin Neonatal
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin Neonatal
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
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
|
|
|
Bilirubin Total
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin Total
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
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
|
|
|
Bilirubin Total
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| 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 |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Bilirubin, Total
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.20
|
| Rate for Payer: Health EOS Commercial |
$56.42
|
| Rate for Payer: HFN Commercial |
$58.90
|
| 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 |
$49.60
|
| Rate for Payer: Preferred Network Access Commercial |
$58.90
|
| Rate for Payer: Quartz Beloit One Network |
$27.28
|
| Rate for Payer: Quartz Commercial |
$35.34
|
| Rate for Payer: The Alliance Commercial |
$31.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Bilirubin, Total
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| 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 |
$32.86
|
| 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 |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| 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 |
$34.70
|
| 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 |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| 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 |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.24
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| 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 |
$46.50
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.24
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Bilirubin, Total
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Bil Nasal Endoscopy w Dilatation Frontal 31296
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
CPT 31296
|
| Hospital Charge Code |
5190611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$4,283.55 |
| Rate for Payer: Aetna Commercial |
$4,283.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.74
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,283.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,705.40
|
| Rate for Payer: Health EOS Commercial |
$4,103.19
|
| Rate for Payer: HFN Commercial |
$4,283.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$591.28
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,283.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.96
|
| Rate for Payer: Quartz Commercial |
$2,570.13
|
| Rate for Payer: The Alliance Commercial |
$2,254.50
|
| Rate for Payer: United Healthcare Medicaid |
$148.96
|
| Rate for Payer: WEA Trust Commercial |
$2,479.95
|
| Rate for Payer: WPS Commercial |
$3,339.82
|
|
|
Bil Nasal Endoscopy w Dilatation Frontal 3129650
|
Professional
|
Both
|
$9,021.00
|
|
|
Service Code
|
CPT 31296 50
|
| Hospital Charge Code |
3451614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$8,569.95 |
| Rate for Payer: Aetna Commercial |
$8,569.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,758.06
|
| Rate for Payer: Cash Price |
$2,706.30
|
| Rate for Payer: Cash Price |
$2,706.30
|
| Rate for Payer: Cigna Commercial |
$8,569.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,412.60
|
| Rate for Payer: Health EOS Commercial |
$8,209.11
|
| Rate for Payer: HFN Commercial |
$8,569.95
|
| Rate for Payer: Multiplan Commercial |
$7,216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,569.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,969.24
|
| Rate for Payer: Quartz Commercial |
$5,141.97
|
| Rate for Payer: The Alliance Commercial |
$4,510.50
|
| Rate for Payer: United Healthcare Medicaid |
$148.96
|
| Rate for Payer: WEA Trust Commercial |
$4,961.55
|
| Rate for Payer: WPS Commercial |
$6,681.85
|
|
|
Bil Nasal Endoscopy w Dilatation Maxillary 31295
|
Professional
|
Both
|
$3,697.00
|
|
|
Service Code
|
CPT 31295
|
| Hospital Charge Code |
5314008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$3,512.15 |
| Rate for Payer: Aetna Commercial |
$3,512.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,179.42
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cigna Commercial |
$3,512.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,218.20
|
| Rate for Payer: Health EOS Commercial |
$3,364.27
|
| Rate for Payer: HFN Commercial |
$3,512.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$520.11
|
| Rate for Payer: Multiplan Commercial |
$2,957.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,512.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,626.68
|
| Rate for Payer: Quartz Commercial |
$2,107.29
|
| Rate for Payer: The Alliance Commercial |
$1,848.50
|
| Rate for Payer: United Healthcare Medicaid |
$124.60
|
| Rate for Payer: WEA Trust Commercial |
$2,033.35
|
| Rate for Payer: WPS Commercial |
$2,738.37
|
|
|
Bil Nasal Endoscopy w Dilatation Maxillary 3129550
|
Professional
|
Both
|
$7,394.00
|
|
|
Service Code
|
CPT 31295 50
|
| Hospital Charge Code |
3451613
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$7,024.30 |
| Rate for Payer: Aetna Commercial |
$7,024.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,358.84
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cigna Commercial |
$7,024.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,436.40
|
| Rate for Payer: Health EOS Commercial |
$6,728.54
|
| Rate for Payer: HFN Commercial |
$7,024.30
|
| Rate for Payer: Multiplan Commercial |
$5,915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,024.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,253.36
|
| Rate for Payer: Quartz Commercial |
$4,214.58
|
| Rate for Payer: The Alliance Commercial |
$3,697.00
|
| Rate for Payer: United Healthcare Medicaid |
$124.60
|
| Rate for Payer: WEA Trust Commercial |
$4,066.70
|
| Rate for Payer: WPS Commercial |
$5,476.74
|
|
|
BINDER ABDOMINAL 12 4-PANEL 30-45" S/M 13651056"
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2969954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$896.00 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Aetna Managed Medicare |
$62.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.35
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$145.60
|
| Rate for Payer: Quartz Medicare Advantage |
$134.40
|
| Rate for Payer: The Alliance Commercial |
$896.00
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
BINDER ABDOMINAL 12 4-PANEL 30-45" S/M 13651056"
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2969954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$206.08 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.72
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$206.08
|
| Rate for Payer: Health EOS Commercial |
$199.36
|
| Rate for Payer: HFN Commercial |
$206.08
|
| Rate for Payer: Multiplan Commercial |
$179.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$206.08
|
| Rate for Payer: Quartz Beloit One Network |
$109.76
|
| Rate for Payer: Quartz Commercial |
$134.40
|
| Rate for Payer: WEA Trust Commercial |
$123.20
|
| Rate for Payer: WPS Commercial |
$165.92
|
|
|
BINDER ABDOMINAL 12 4-PANEL 46-62" M/L 13652067"
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$2,884.00 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Aetna Managed Medicare |
$201.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.47
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.75
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$468.65
|
| Rate for Payer: Quartz Medicare Advantage |
$432.60
|
| Rate for Payer: The Alliance Commercial |
$2,884.00
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
BINDER ABDOMINAL 12 4-PANEL 46-62" M/L 13652067"
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963951
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
BINDER ABDOMINAL 12 4-PANEL 63-74" L 13653008"
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
2963899
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$88.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$189.60
|
| Rate for Payer: The Alliance Commercial |
$1,264.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BINDER ABDOMINAL 12 4-PANEL 75-84" XL 13654009"
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$75.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.65
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.25
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$162.60
|
| Rate for Payer: The Alliance Commercial |
$1,084.00
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
BINDER ABDOMINAL 12 4-PANEL 85-94"X XL 13655010"
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS L0625
|
| Hospital Charge Code |
4491021
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
