|
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 |
$4.40 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.30
|
| Rate for Payer: Anthem Medicare Advantage |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.40
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.40
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$4.40
|
| Rate for Payer: The Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
BLOOD PATCH
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
2959849
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$742.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| 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 |
$278.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$742.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$742.86
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,763.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$742.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$742.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$742.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$742.86
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.29
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$742.86
|
| Rate for Payer: The Alliance Commercial |
$2,971.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.86
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: Wellcare Medicare |
$742.86
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
BLOOD PATCH
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
2959849
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
BLOOD PRESSURE MACHINE
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS A4670
|
| Hospital Charge Code |
3075875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$58.76
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
BLOOD PRESSURE MACHINE
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS A4670
|
| Hospital Charge Code |
3075875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Blood pressure machine - Devices and Equipment
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
3002380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Blood pressure machine - Devices and Equipment
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
3002380
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$34.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$73.63
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$73.63
|
| Rate for Payer: The Alliance Commercial |
$61.36
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
BLOOD PROCESSING, STORAGE AND RELATED SERVICES
|
Facility
|
OP
|
$32.76
|
|
|
Service Code
|
EAPG 00499
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Anthem Medicaid |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.50
|
| Rate for Payer: Dean Health Medicaid |
$31.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31.50
|
| Rate for Payer: Managed Health Services Medicaid |
$32.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.50
|
|
|
Blood Transfusion 0-2 Hr
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040439
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.89
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$107.64
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Blood Transfusion 0-2 Hr
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040439
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Blood Transfusion 2 - 4 Hours
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040440
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$206.67 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.67
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$322.92
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Blood Transfusion 2 - 4 Hours
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040440
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Blood Transfusion 4 - 6 Hours
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040441
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$428.69
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
Blood Transfusion 4 - 6 Hours
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040441
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$342.95 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.95
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$464.41
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$535.86
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
Blood Transfusion 6 - 12 Hours
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040442
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$464.29 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,159.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.16
|
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$837.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$644.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$618.51
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,185.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Health EOS Commercial |
$1,146.82
|
| Rate for Payer: HFN Commercial |
$1,185.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: Multiplan Commercial |
$1,030.85
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.48
|
| Rate for Payer: Quartz Beloit One Network |
$631.39
|
| Rate for Payer: Quartz Commercial |
$837.56
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$966.42
|
| Rate for Payer: WEA Trust Commercial |
$708.71
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
| Rate for Payer: WPS Commercial |
$954.40
|
|
|
Blood Transfusion 6 - 12 Hours
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3040442
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$631.39 |
| Max. Negotiated Rate |
$1,185.48 |
| Rate for Payer: Aetna Commercial |
$1,159.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.94
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna Commercial |
$1,185.48
|
| Rate for Payer: Health EOS Commercial |
$1,146.82
|
| Rate for Payer: HFN Commercial |
$1,185.48
|
| Rate for Payer: Multiplan Commercial |
$1,030.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.48
|
| Rate for Payer: Quartz Beloit One Network |
$631.39
|
| Rate for Payer: Quartz Commercial |
$773.14
|
| Rate for Payer: WEA Trust Commercial |
$708.71
|
| Rate for Payer: WPS Commercial |
$954.40
|
|
|
Blood tubing, Hi Flo gravity - IV Equipment/Supplies
|
Facility
|
OP
|
$823.00
|
|
| Hospital Charge Code |
3000007
|
| Min. Negotiated Rate |
$239.66 |
| Max. Negotiated Rate |
$787.45 |
| Rate for Payer: Aetna Commercial |
$770.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.09
|
| Rate for Payer: Aetna Managed Medicare |
$239.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$556.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.64
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$787.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.99
|
| Rate for Payer: Health EOS Commercial |
$761.77
|
| Rate for Payer: HFN Commercial |
$787.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.94
|
| Rate for Payer: Multiplan Commercial |
$684.74
|
| Rate for Payer: NAPHCARE Commercial |
$513.55
|
| Rate for Payer: Preferred Network Access Commercial |
$787.45
|
| Rate for Payer: Quartz Beloit One Network |
$419.40
|
| Rate for Payer: Quartz Commercial |
$556.35
|
| Rate for Payer: Quartz Medicare Advantage |
$513.55
|
| Rate for Payer: The Alliance Commercial |
$427.96
|
| Rate for Payer: WEA Trust Commercial |
$470.76
|
| Rate for Payer: WPS Commercial |
$633.96
|
|
|
Blood tubing, Hi Flo gravity - IV Equipment/Supplies
|
Facility
|
IP
|
$823.00
|
|
| Hospital Charge Code |
3000007
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$787.45 |
| Rate for Payer: Aetna Commercial |
$770.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$736.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.64
|
| Rate for Payer: Cash Price |
$246.90
|
| Rate for Payer: Cigna Commercial |
$787.45
|
| Rate for Payer: Health EOS Commercial |
$761.77
|
| Rate for Payer: HFN Commercial |
$787.45
|
| Rate for Payer: Multiplan Commercial |
$684.74
|
| Rate for Payer: Preferred Network Access Commercial |
$787.45
|
| Rate for Payer: Quartz Beloit One Network |
$419.40
|
| Rate for Payer: Quartz Commercial |
$513.55
|
| Rate for Payer: WEA Trust Commercial |
$470.76
|
| Rate for Payer: WPS Commercial |
$633.96
|
|
|
Blood tubing, Hi Flo gravity - Peripheral IV Equipment:
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
2999915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Aetna Managed Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.61
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: NAPHCARE Commercial |
$533.52
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$577.98
|
| Rate for Payer: Quartz Medicare Advantage |
$533.52
|
| Rate for Payer: The Alliance Commercial |
$444.60
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
Blood tubing, Hi Flo gravity - Peripheral IV Equipment:
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
2999915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$435.71 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$533.52
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
Blood tubing, secondary - IV Equipment/Supplies
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
3000006
|
| Min. Negotiated Rate |
$23.30 |
| 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 |
$23.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.94
|
| 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: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$49.92
|
| 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 |
$49.92
|
| Rate for Payer: The Alliance Commercial |
$41.60
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Blood tubing, secondary - IV Equipment/Supplies
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
3000006
|
| 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
|
|
|
Blood tubing, secondary - Peripheral IV Equipment:
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2999914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Blood tubing, secondary - Peripheral IV Equipment:
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2999914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Blood Type ABO/Rh Typing
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
634326
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$103.33 |
| Rate for Payer: Aetna Commercial |
$101.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.53
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$103.33
|
| Rate for Payer: Health EOS Commercial |
$99.96
|
| Rate for Payer: HFN Commercial |
$103.33
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$103.33
|
| Rate for Payer: Quartz Beloit One Network |
$55.04
|
| Rate for Payer: Quartz Commercial |
$67.39
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$83.19
|
|
