|
BLOCK SPHENOPALATINE GANGLION
|
Facility
IP
|
$1,218.00
|
|
| Hospital Charge Code |
5262687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
BLOCK, STELLATE GANGLION
|
Facility
OP
|
$913.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
2960388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$12,418.92 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$785.18
|
| Rate for Payer: Aetna Managed Medicare |
$900.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$900.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$900.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$900.91
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$900.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$900.91
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,351.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$900.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$900.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$900.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$900.91
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,351.36
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$593.45
|
| Rate for Payer: Quartz Medicare Advantage |
$900.91
|
| Rate for Payer: The Alliance Commercial |
$12,418.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$900.91
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: Wellcare Medicare |
$900.91
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
BLOCK, STELLATE GANGLION
|
Facility
IP
|
$913.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
2960388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.37 |
| Max. Negotiated Rate |
$839.96 |
| Rate for Payer: Aetna Commercial |
$821.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.89
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cigna Commercial |
$839.96
|
| Rate for Payer: Health EOS Commercial |
$812.57
|
| Rate for Payer: HFN Commercial |
$839.96
|
| Rate for Payer: Multiplan Commercial |
$730.40
|
| Rate for Payer: NAPHCARE Commercial |
$547.80
|
| Rate for Payer: Preferred Network Access Commercial |
$839.96
|
| Rate for Payer: Quartz Beloit One Network |
$447.37
|
| Rate for Payer: Quartz Commercial |
$547.80
|
| Rate for Payer: WEA Trust Commercial |
$502.15
|
| Rate for Payer: WPS Commercial |
$676.26
|
|
|
BLOCK SZ 7 TIB AUGMENT LCCK 5988-07-26
|
Facility
IP
|
$8,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2969413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,998.40 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,324.80
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna Commercial |
$7,507.20
|
| Rate for Payer: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,896.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,507.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,998.40
|
| Rate for Payer: Quartz Commercial |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
BLOCK SZ 7 TIB AUGMENT LCCK 5988-07-26
|
Facility
OP
|
$8,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2969413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,284.80 |
| Max. Negotiated Rate |
$7,507.20 |
| Rate for Payer: Aetna Commercial |
$7,344.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,017.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,284.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,304.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,080.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,916.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,324.80
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna Commercial |
$7,507.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,566.34
|
| Rate for Payer: Health EOS Commercial |
$7,262.40
|
| Rate for Payer: HFN Commercial |
$7,507.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,120.00
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,896.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,507.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,998.40
|
| Rate for Payer: Quartz Commercial |
$5,304.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,896.00
|
| Rate for Payer: WEA Trust Commercial |
$4,488.00
|
| Rate for Payer: WPS Commercial |
$6,044.11
|
|
|
BLOCK WITH GENERAL ANES - SET-UP CHARGE
|
Facility
OP
|
$1,668.00
|
|
| Hospital Charge Code |
4519582
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$6,672.00 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,434.48
|
| Rate for Payer: Aetna Managed Medicare |
$467.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,084.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$834.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$800.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.41
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.00
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,084.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.80
|
| Rate for Payer: The Alliance Commercial |
$6,672.00
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
BLOCK WITH GENERAL ANES - SET-UP CHARGE
|
Facility
IP
|
$1,668.00
|
|
| Hospital Charge Code |
4519582
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$817.32 |
| Max. Negotiated Rate |
$1,534.56 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,000.80
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
BLOCK WITH MAC ANES - SET-UP CHARGE
|
Facility
IP
|
$1,303.00
|
|
| Hospital Charge Code |
4519581
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$638.47 |
| Max. Negotiated Rate |
$1,198.76 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$781.80
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
BLOCK WITH MAC ANES - SET-UP CHARGE
|
Facility
OP
|
$1,303.00
|
|
| Hospital Charge Code |
4519581
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$364.84 |
| Max. Negotiated Rate |
$5,212.00 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Aetna Managed Medicare |
$364.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$729.16
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$846.95
|
| Rate for Payer: Quartz Medicare Advantage |
$781.80
|
| Rate for Payer: The Alliance Commercial |
$5,212.00
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
Blood Culture
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
633882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$1,208.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$1,208.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$226.50
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
Blood Culture
|
Facility
IP
|
$302.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
633882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
Blood Culture
|
Professional
|
$302.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
633882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$286.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$274.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$286.90
|
| Rate for Payer: Quartz Beloit One Network |
$132.88
|
| Rate for Payer: Quartz Commercial |
$172.14
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$45.41
|
|
|
Blood Gas Arterial
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$346.59
|
|
|
Blood Gas Arterial
|
Facility
OP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.76
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$78.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Managed Health Services Medicaid |
$41.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.16
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.91
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$2,152.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Healthcare PPO |
$403.50
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$78.77
|
| Rate for Payer: WMAP Medicaid |
$39.91
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Arterial
|
Facility
IP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Capillary
|
Facility
OP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.76
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$78.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Managed Health Services Medicaid |
$41.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.16
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.91
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$2,152.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Healthcare PPO |
$403.50
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$78.77
|
| Rate for Payer: WMAP Medicaid |
$39.91
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Capillary
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$346.59
|
|
|
Blood Gas Capillary
|
Facility
IP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Venous
|
Facility
IP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Venous
|
Facility
OP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.76
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$78.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Managed Health Services Medicaid |
$41.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.16
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.91
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$2,152.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Healthcare PPO |
$403.50
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$78.77
|
| Rate for Payer: WMAP Medicaid |
$39.91
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Blood Gas Venous
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$346.59
|
|
|
Blood Glucose, Capillary
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
681592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.37
|
| Rate for Payer: Anthem Medicaid |
$4.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.04
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.45
|
| Rate for Payer: Dean Health Medicaid |
$4.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.04
|
| Rate for Payer: Managed Health Services Medicaid |
$4.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.56
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.45
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.04
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$5.04
|
| Rate for Payer: WMAP Medicaid |
$4.45
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Blood Glucose, Capillary
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
681592
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
BLOOD PATCH
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
2959849
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
BLOOD PATCH
|
Facility
OP
|
$291.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
2959849
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$8,905.92 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$683.53
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$683.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$683.53
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$683.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$683.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$683.53
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$189.15
|
| Rate for Payer: Quartz Medicare Advantage |
$683.53
|
| Rate for Payer: The Alliance Commercial |
$8,905.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.53
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
