|
ICD Removal Subq Lead Only
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
4584632
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$4,385.97 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$2,860.42
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
|
ICD REM&REP Gen + AV & CS Leads
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318616
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD REM&REP Gen + AV & CS Leads
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318616
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD REM&REP Gen + Single/Dual Leads
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD REM&REP Gen + Single/Dual Leads
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD Repos Subq Lead Only
|
Facility
|
OP
|
$4,276.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
4584631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,179.05 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$4,002.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,824.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$4,091.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$3,957.87
|
| Rate for Payer: HFN Commercial |
$4,091.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$3,557.63
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,091.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,179.05
|
| Rate for Payer: Quartz Commercial |
$2,890.58
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,445.87
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$3,293.80
|
|
|
ICD Repos Subq Lead Only
|
Facility
|
IP
|
$4,276.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
4584631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,179.05 |
| Max. Negotiated Rate |
$4,091.28 |
| Rate for Payer: Aetna Commercial |
$4,002.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,824.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.93
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$4,091.28
|
| Rate for Payer: Health EOS Commercial |
$3,957.87
|
| Rate for Payer: HFN Commercial |
$4,091.28
|
| Rate for Payer: Multiplan Commercial |
$3,557.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,091.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,179.05
|
| Rate for Payer: Quartz Commercial |
$2,668.22
|
| Rate for Payer: WEA Trust Commercial |
$2,445.87
|
| Rate for Payer: WPS Commercial |
$3,293.80
|
|
|
ICD Subq Check w/o Repgrogram
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
4584636
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$1,262.98 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.94
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$892.32
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
ICD Subq Check w/o Repgrogram
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
4584636
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$672.67 |
| Max. Negotiated Rate |
$1,262.98 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$823.68
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
ICD Subq Check w/ Reprogram
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
4584635
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$741.98 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$908.54
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
ICD Subq Check w/ Reprogram
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
4584635
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$1,393.10 |
| Rate for Payer: Aetna Commercial |
$1,362.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.25
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.84
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,393.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,393.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$1,211.39
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.10
|
| Rate for Payer: Quartz Beloit One Network |
$741.98
|
| Rate for Payer: Quartz Commercial |
$984.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$1,135.68
|
| Rate for Payer: WEA Trust Commercial |
$832.83
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$1,121.56
|
|
|
ICD Upgrade Dual Lead to BI-V
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
4308789
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,027.19 |
| Max. Negotiated Rate |
$3,806.15 |
| Rate for Payer: Aetna Commercial |
$3,723.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,557.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,192.67
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$3,806.15
|
| Rate for Payer: Health EOS Commercial |
$3,682.04
|
| Rate for Payer: HFN Commercial |
$3,806.15
|
| Rate for Payer: Multiplan Commercial |
$3,309.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,806.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,027.19
|
| Rate for Payer: Quartz Commercial |
$2,482.27
|
| Rate for Payer: WEA Trust Commercial |
$2,275.42
|
| Rate for Payer: WPS Commercial |
$3,064.25
|
|
|
ICD Upgrade Dual Lead to BI-V
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
4308789
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,158.39 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,723.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,557.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,158.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,689.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,068.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,985.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,192.67
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$3,806.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$3,682.04
|
| Rate for Payer: HFN Commercial |
$3,806.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,102.84
|
| Rate for Payer: Multiplan Commercial |
$3,309.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,482.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,806.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,027.19
|
| Rate for Payer: Quartz Commercial |
$2,689.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,482.27
|
| Rate for Payer: The Alliance Commercial |
$1,446.93
|
| Rate for Payer: WEA Trust Commercial |
$2,275.42
|
| Rate for Payer: WPS Commercial |
$3,064.25
|
|
|
ICD Upgrade Single to Dual
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD Upgrade Single to Dual
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
Ice Pack
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
3040326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Ice Pack
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
3040326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Ic/Id Skin Test W/Allergenic Extracts, Immediate Reaction 95024
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
1188809
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.79
|
| Rate for Payer: Anthem Medicare Advantage |
$0.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.79
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.79
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2.96
|
| Rate for Payer: Quartz Beloit One Network |
$1.37
|
| Rate for Payer: Quartz Commercial |
$1.78
|
| Rate for Payer: Quartz Medicare Advantage |
$0.79
|
| Rate for Payer: The Alliance Commercial |
$1.98
|
| Rate for Payer: United Healthcare Medicaid |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.79
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$3.16
|
|
|
I&D abscess complicated or multiple 10061
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3013503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$759.38 |
| Rate for Payer: Aetna Commercial |
$560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$168.75
|
| Rate for Payer: Anthem Medicare Advantage |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.75
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$560.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.75
|
| Rate for Payer: Health EOS Commercial |
$536.61
|
| Rate for Payer: HFN Commercial |
$560.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$635.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$635.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.75
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$253.13
|
| Rate for Payer: Preferred Network Access Commercial |
$560.20
|
| Rate for Payer: Quartz Beloit One Network |
$259.46
|
| Rate for Payer: Quartz Commercial |
$336.12
|
| Rate for Payer: Quartz Medicare Advantage |
$168.75
|
| Rate for Payer: The Alliance Commercial |
$717.19
|
| Rate for Payer: United Healthcare Medicaid |
$95.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$759.38
|
|
|
I&D abscess simple or single 10060
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
1188870
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$445.35 |
| Rate for Payer: Aetna Commercial |
$306.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Aetna Managed Medicare |
$98.97
|
| Rate for Payer: Anthem Medicare Advantage |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.97
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$306.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.97
|
| Rate for Payer: Health EOS Commercial |
$293.38
|
| Rate for Payer: HFN Commercial |
$306.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$361.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.97
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: NAPHCARE Commercial |
$148.45
|
| Rate for Payer: Preferred Network Access Commercial |
$306.28
|
| Rate for Payer: Quartz Beloit One Network |
$141.86
|
| Rate for Payer: Quartz Commercial |
$183.77
|
| Rate for Payer: Quartz Medicare Advantage |
$98.97
|
| Rate for Payer: The Alliance Commercial |
$420.61
|
| Rate for Payer: United Healthcare Medicaid |
$42.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.97
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$445.35
|
|
|
I&D abscess simple or single 22999-10060
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6180262
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.29 |
| Max. Negotiated Rate |
$505.86 |
| Rate for Payer: Aetna Commercial |
$505.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.93
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$505.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.49
|
| Rate for Payer: Health EOS Commercial |
$484.56
|
| Rate for Payer: HFN Commercial |
$505.86
|
| Rate for Payer: Multiplan Commercial |
$425.98
|
| Rate for Payer: Preferred Network Access Commercial |
$505.86
|
| Rate for Payer: Quartz Beloit One Network |
$234.29
|
| Rate for Payer: Quartz Commercial |
$303.51
|
| Rate for Payer: The Alliance Commercial |
$266.24
|
| Rate for Payer: WEA Trust Commercial |
$292.86
|
| Rate for Payer: WPS Commercial |
$394.39
|
|
|
I&D below fascia, w or w/o tendon sheath involvement, foot, multiple areas 28002
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
3014175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.11 |
| Max. Negotiated Rate |
$1,289.34 |
| Rate for Payer: Aetna Commercial |
$1,289.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Aetna Managed Medicare |
$125.11
|
| Rate for Payer: Anthem Medicare Advantage |
$125.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.11
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,289.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.11
|
| Rate for Payer: Health EOS Commercial |
$1,235.05
|
| Rate for Payer: HFN Commercial |
$1,289.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,107.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,107.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.11
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: NAPHCARE Commercial |
$187.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.34
|
| Rate for Payer: Quartz Beloit One Network |
$597.17
|
| Rate for Payer: Quartz Commercial |
$773.60
|
| Rate for Payer: Quartz Medicare Advantage |
$125.11
|
| Rate for Payer: The Alliance Commercial |
$531.73
|
| Rate for Payer: United Healthcare Medicaid |
$146.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.11
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$563.00
|
|
|
I&D bursa, foot 28001
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
4546785
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$591.25 |
| Rate for Payer: Aetna Commercial |
$474.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$85.30
|
| Rate for Payer: Anthem Medicare Advantage |
$85.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.30
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$474.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.30
|
| Rate for Payer: Health EOS Commercial |
$454.27
|
| Rate for Payer: HFN Commercial |
$474.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$591.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.30
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$127.95
|
| Rate for Payer: Preferred Network Access Commercial |
$474.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.65
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: Quartz Medicare Advantage |
$85.30
|
| Rate for Payer: The Alliance Commercial |
$362.53
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.30
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$383.85
|
|
|
Identification, Aerobic to Mayo
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$276.64 |
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$276.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$264.99
|
| Rate for Payer: HFN Commercial |
$276.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$276.64
|
| Rate for Payer: Quartz Beloit One Network |
$128.13
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Identification, Aerobic to Mayo
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$189.28
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: United Healthcare PPO |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: Wellcare Medicare |
$8.40
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
