|
Bicillin LA 1.2mu syringe [Med]
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2974914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Aetna Managed Medicare |
$33.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.47
|
| Rate for Payer: Anthem Medicare Advantage |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.25
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.25
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: NAPHCARE Commercial |
$49.87
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$444.81
|
| Rate for Payer: Quartz Medicare Advantage |
$33.25
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.25
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: Wellcare Medicare |
$33.25
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
Bicitra 30ml UD cup [Med]
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
2974915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Bicitra 30ml UD cup [Med]
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
2974915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
BIER BLOCK - SET-UP CHARGE
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
4519593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$29.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$63.65
|
| Rate for Payer: The Alliance Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
BIER BLOCK - SET-UP CHARGE
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
4519593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Bilateral - Ear, impacted cerumen removal
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Bilateral - Ear, impacted cerumen removal
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$188,860.88
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$42,802.99 |
| Max. Negotiated Rate |
$188,860.88 |
| Rate for Payer: Aetna Managed Medicare |
$42,802.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89,651.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85,175.22
|
| Rate for Payer: Anthem Medicare Advantage |
$42,802.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,802.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,802.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,802.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94,552.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,802.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138,279.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,802.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,802.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,802.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,802.99
|
| Rate for Payer: NAPHCARE Commercial |
$64,204.48
|
| Rate for Payer: Quartz Medicare Advantage |
$42,802.99
|
| Rate for Payer: The Alliance Commercial |
$188,860.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,802.99
|
| Rate for Payer: United Healthcare PPO |
$107,652.12
|
| Rate for Payer: Wellcare Medicare |
$42,802.99
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$79,031.68
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$20,877.58 |
| Max. Negotiated Rate |
$79,031.68 |
| Rate for Payer: Aetna Managed Medicare |
$20,877.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58,039.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44,486.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,265.06
|
| Rate for Payer: Anthem Medicare Advantage |
$20,877.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,877.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,877.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,877.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,918.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,877.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,722.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,877.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,877.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,877.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,877.58
|
| Rate for Payer: NAPHCARE Commercial |
$31,316.38
|
| Rate for Payer: Quartz Medicare Advantage |
$20,877.58
|
| Rate for Payer: The Alliance Commercial |
$79,031.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,877.58
|
| Rate for Payer: United Healthcare PPO |
$44,938.07
|
| Rate for Payer: Wellcare Medicare |
$20,877.58
|
|
|
Bile Acids, Fractionated and Total
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Bile Acids, Fractionated and Total
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$100.21 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$66.30
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
Bile Acids, Fractionated and Total
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5228609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$110.24 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
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 |
$25.07 |
| 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 |
$25.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.62
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| 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 |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| 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 |
$25.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| 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 |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$25.07
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
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 |
$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
|
|
|
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 |
$25.07 |
| 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 |
$25.07
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| 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 |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| 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 |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$99.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$110.33
|
|
|
BILIARY BYPASS GRAFT
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2959842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
BILIARY BYPASS GRAFT
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2959842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$54,451.28
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$17,180.98 |
| Max. Negotiated Rate |
$54,451.28 |
| Rate for Payer: Aetna Managed Medicare |
$17,180.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,506.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,413.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,595.38
|
| Rate for Payer: Anthem Medicare Advantage |
$17,180.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,180.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,180.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,180.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,404.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,180.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,694.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,180.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,180.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,180.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,180.98
|
| Rate for Payer: NAPHCARE Commercial |
$25,771.47
|
| Rate for Payer: Quartz Medicare Advantage |
$17,180.98
|
| Rate for Payer: The Alliance Commercial |
$54,451.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,180.98
|
| Rate for Payer: United Healthcare PPO |
$30,902.32
|
| Rate for Payer: Wellcare Medicare |
$17,180.98
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$103,250.16
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$27,812.84 |
| Max. Negotiated Rate |
$103,250.16 |
| Rate for Payer: Aetna Managed Medicare |
$27,812.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,798.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,631.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,654.25
|
| Rate for Payer: Anthem Medicare Advantage |
$27,812.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,812.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,812.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,812.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,891.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,812.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,486.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,812.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,812.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,812.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,812.84
|
| Rate for Payer: NAPHCARE Commercial |
$41,719.27
|
| Rate for Payer: Quartz Medicare Advantage |
$27,812.84
|
| Rate for Payer: The Alliance Commercial |
$103,250.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,812.84
|
| Rate for Payer: United Healthcare PPO |
$58,766.99
|
| Rate for Payer: Wellcare Medicare |
$27,812.84
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$43,610.32
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$12,665.70 |
| Max. Negotiated Rate |
$43,610.32 |
| Rate for Payer: Aetna Managed Medicare |
$12,665.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,642.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,553.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,227.16
|
| Rate for Payer: Anthem Medicare Advantage |
$12,665.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,665.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,665.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,665.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,004.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,665.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,742.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,665.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,665.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,665.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,665.70
|
| Rate for Payer: NAPHCARE Commercial |
$18,998.55
|
| Rate for Payer: Quartz Medicare Advantage |
$12,665.70
|
| Rate for Payer: The Alliance Commercial |
$43,610.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,665.70
|
| Rate for Payer: United Healthcare PPO |
$24,711.75
|
| Rate for Payer: Wellcare Medicare |
$12,665.70
|
|
|
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 |
$129.01 |
| Max. Negotiated Rate |
$2,218.06 |
| Rate for Payer: Aetna Commercial |
$2,218.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,007.93
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$2,218.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,400.88
|
| Rate for Payer: Health EOS Commercial |
$2,124.67
|
| Rate for Payer: HFN Commercial |
$2,218.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.45
|
| Rate for Payer: Multiplan Commercial |
$1,867.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,218.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,027.31
|
| Rate for Payer: Quartz Commercial |
$1,330.84
|
| Rate for Payer: The Alliance Commercial |
$1,167.40
|
| Rate for Payer: United Healthcare Medicaid |
$129.01
|
| Rate for Payer: WEA Trust Commercial |
$1,284.14
|
| Rate for Payer: WPS Commercial |
$1,729.32
|
|
|
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 |
$63.23 |
| Max. Negotiated Rate |
$1,359.49 |
| Rate for Payer: Aetna Commercial |
$1,359.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,359.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.62
|
| Rate for Payer: Health EOS Commercial |
$1,302.25
|
| Rate for Payer: HFN Commercial |
$1,359.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.36
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.49
|
| Rate for Payer: Quartz Beloit One Network |
$629.66
|
| Rate for Payer: Quartz Commercial |
$815.69
|
| Rate for Payer: The Alliance Commercial |
$715.52
|
| Rate for Payer: United Healthcare Medicaid |
$63.23
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
Bilirubin, Body Fluid
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
Bilirubin, Body Fluid
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$127.25 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$127.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$123.10
|
| Rate for Payer: HFN Commercial |
$127.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$110.66
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$127.25
|
| Rate for Payer: Quartz Beloit One Network |
$67.78
|
| Rate for Payer: Quartz Commercial |
$89.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$103.74
|
| Rate for Payer: WEA Trust Commercial |
$76.08
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$102.45
|
|
|
Bilirubin Direct
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
981837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
