|
Bilirubin Direct
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
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
|
|
|
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
|
|
|
Bilirubin Direct
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| 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 |
$47.40
|
| 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 |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| 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 |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| 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 |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Bilirubin Direct
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Bilirubin Direct
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
981837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Bilirubin Neonatal
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$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 |
$44.10
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| 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 |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$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 |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Neonatal
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$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 |
$44.10
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| 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 |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$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 |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Neonatal
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Bilirubin Neonatal
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Neonatal
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
977881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Bilirubin Neonatal
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
981836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Total
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Total
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$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 |
$44.10
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| 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 |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$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 |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Bilirubin Total
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Bilirubin, Total
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| 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 |
$34.17
|
| 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 |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| 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 |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| 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 |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Bilirubin, Total
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Bilirubin, Total
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4812607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| 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 |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
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 |
$146.44 |
| Max. Negotiated Rate |
$4,454.89 |
| Rate for Payer: Aetna Commercial |
$4,454.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,032.85
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Medicare Advantage |
$146.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.44
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,454.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.44
|
| Rate for Payer: Health EOS Commercial |
$4,267.32
|
| Rate for Payer: HFN Commercial |
$4,454.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$614.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$614.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.44
|
| Rate for Payer: Multiplan Commercial |
$3,751.49
|
| Rate for Payer: NAPHCARE Commercial |
$219.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,454.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,063.32
|
| Rate for Payer: Quartz Commercial |
$2,672.94
|
| Rate for Payer: Quartz Medicare Advantage |
$146.44
|
| Rate for Payer: The Alliance Commercial |
$622.38
|
| Rate for Payer: United Healthcare Medicaid |
$154.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.44
|
| Rate for Payer: WEA Trust Commercial |
$2,579.15
|
| Rate for Payer: WPS Commercial |
$658.99
|
|
|
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 |
$154.92 |
| Max. Negotiated Rate |
$8,912.75 |
| Rate for Payer: Aetna Commercial |
$8,912.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,068.38
|
| Rate for Payer: Cash Price |
$2,706.30
|
| Rate for Payer: Cash Price |
$2,706.30
|
| Rate for Payer: Cash Price |
$2,706.30
|
| Rate for Payer: Cigna Commercial |
$8,912.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,629.10
|
| Rate for Payer: Health EOS Commercial |
$8,537.47
|
| Rate for Payer: HFN Commercial |
$8,912.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$614.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$614.93
|
| Rate for Payer: Multiplan Commercial |
$7,505.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,912.75
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.01
|
| Rate for Payer: Quartz Commercial |
$5,347.65
|
| Rate for Payer: The Alliance Commercial |
$4,690.92
|
| Rate for Payer: United Healthcare Medicaid |
$154.92
|
| Rate for Payer: WEA Trust Commercial |
$5,160.01
|
| Rate for Payer: WPS Commercial |
$6,948.88
|
|
|
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 |
$129.47 |
| Max. Negotiated Rate |
$3,652.64 |
| Rate for Payer: Aetna Commercial |
$3,652.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.60
|
| Rate for Payer: Aetna Managed Medicare |
$129.47
|
| Rate for Payer: Anthem Medicare Advantage |
$129.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.47
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cash Price |
$1,109.10
|
| Rate for Payer: Cigna Commercial |
$3,652.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.47
|
| Rate for Payer: Health EOS Commercial |
$3,498.84
|
| Rate for Payer: HFN Commercial |
$3,652.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$540.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.47
|
| Rate for Payer: Multiplan Commercial |
$3,075.90
|
| Rate for Payer: NAPHCARE Commercial |
$194.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.75
|
| Rate for Payer: Quartz Commercial |
$2,191.58
|
| Rate for Payer: Quartz Medicare Advantage |
$129.47
|
| Rate for Payer: The Alliance Commercial |
$550.25
|
| Rate for Payer: United Healthcare Medicaid |
$129.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.47
|
| Rate for Payer: WEA Trust Commercial |
$2,114.68
|
| Rate for Payer: WPS Commercial |
$582.61
|
|
|
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 |
$129.58 |
| Max. Negotiated Rate |
$7,305.27 |
| Rate for Payer: Aetna Commercial |
$7,305.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,613.19
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cash Price |
$2,218.20
|
| Rate for Payer: Cigna Commercial |
$7,305.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,613.86
|
| Rate for Payer: Health EOS Commercial |
$6,997.68
|
| Rate for Payer: HFN Commercial |
$7,305.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$540.91
|
| Rate for Payer: Multiplan Commercial |
$6,151.81
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,383.49
|
| Rate for Payer: Quartz Commercial |
$4,383.16
|
| Rate for Payer: The Alliance Commercial |
$3,844.88
|
| Rate for Payer: United Healthcare Medicaid |
$129.58
|
| Rate for Payer: WEA Trust Commercial |
$4,229.37
|
| Rate for Payer: WPS Commercial |
$5,695.60
|
|
|
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 |
$46.57 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$65.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.37
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.72
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$151.42
|
| Rate for Payer: Quartz Medicare Advantage |
$139.78
|
| Rate for Payer: The Alliance Commercial |
$151.13
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
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 |
$114.15 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$139.78
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
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 |
$46.57 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$209.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$419.62
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$562.38
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$449.90
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$449.90
|
| Rate for Payer: The Alliance Commercial |
$151.13
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
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 |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
