|
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: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| 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 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 |
$494.96 |
| 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 DHI/DHP/ASO |
$301.06
|
| 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 |
$315.08
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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 Arterial
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633675
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.72 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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 |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| 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: 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: The Alliance Commercial |
$269.00
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633676
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.72 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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 |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| 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: 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: The Alliance Commercial |
$269.00
|
| 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 |
$494.96 |
| 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 DHI/DHP/ASO |
$301.06
|
| 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 |
$315.08
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
633677
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.72 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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 |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| 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: 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: The Alliance Commercial |
$269.00
|
| 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 |
$494.96 |
| 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 DHI/DHP/ASO |
$301.06
|
| 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 |
$315.08
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| 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 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 |
$70.84 |
| 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 DHI/DHP/ASO |
$43.09
|
| 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 |
$20.16
|
| 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, occult, pt provided with 3 take home cards POC 82272
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
1190881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Blood, occult, pt provided with 3 take home cards POC 82272
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
1190881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$4.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.02
|
| Rate for Payer: Anthem Medicaid |
$4.26
|
| Rate for Payer: Anthem Medicare Advantage |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.23
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Dean Health Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.23
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.23
|
| Rate for Payer: Managed Health Services Medicaid |
$4.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.34
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.26
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.23
|
| Rate for Payer: The Alliance Commercial |
$16.92
|
| Rate for Payer: United Healthcare Medicaid |
$4.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.23
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$4.23
|
| Rate for Payer: WMAP Medicaid |
$4.26
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Blood, occult, pt provided with 3 take home cards POC 82272
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 82272
|
| Hospital Charge Code |
1190881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: HFN Commercial |
$46.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.93
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: The Alliance Commercial |
$24.50
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
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 |
$4,218.22 |
| 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 |
$2,734.12
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| 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 PRESSURE MACHINE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS A4670
|
| Hospital Charge Code |
3075875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
BLOOD PRESSURE MACHINE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS A4670
|
| Hospital Charge Code |
3075875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$31.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.23
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$67.80
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Blood pressure machine - Devices and Equipment
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
3002380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Blood pressure machine - Devices and Equipment
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
3002380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$33.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$70.80
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Blood Transfusion 0-2 Hr
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040439
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Blood Transfusion 0-2 Hr
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040439
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$429.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Anthem Medicare Advantage |
$429.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$429.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$429.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$429.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$429.07
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$429.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$429.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$429.07
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$643.60
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$429.07
|
| Rate for Payer: The Alliance Commercial |
$1,716.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$429.07
|
| Rate for Payer: United Healthcare PPO |
$103.50
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: Wellcare Medicare |
$429.07
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Blood Transfusion 2 - 4 Hours
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040440
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$198.72 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$429.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.72
|
| Rate for Payer: Anthem Medicare Advantage |
$429.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$429.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$429.07
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$429.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$429.07
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$429.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$429.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$429.07
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$643.60
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$429.07
|
| Rate for Payer: The Alliance Commercial |
$1,716.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$429.07
|
| Rate for Payer: United Healthcare PPO |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: Wellcare Medicare |
$429.07
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Blood Transfusion 2 - 4 Hours
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040440
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
