|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 64493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$930.81 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$930.81
|
| 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 |
$930.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$930.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$930.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$930.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$930.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,462.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$930.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$930.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$930.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$930.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.22
|
| Rate for Payer: Quartz Medicare Advantage |
$930.81
|
| Rate for Payer: The Alliance Commercial |
$3,723.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$930.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$930.81
|
|
|
INJECTION(S) FOR RADIOLOGICAL IMAGING
|
Facility
|
OP
|
$331.51
|
|
|
Service Code
|
EAPG 00278
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$331.51 |
| Rate for Payer: Anthem Medicaid |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$318.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.75
|
| Rate for Payer: Dean Health Medicaid |
$318.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$318.75
|
| Rate for Payer: Managed Health Services Medicaid |
$331.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$318.75
|
| Rate for Payer: United Healthcare Medicaid |
$318.75
|
|
|
Injection; Single or Multiple Trigger Points 2055250
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 20552 50
|
| Hospital Charge Code |
5273115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.39
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: The Alliance Commercial |
$100.88
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 62321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$742.86 |
| Max. Negotiated Rate |
$4,386.95 |
| 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 Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| 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: 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: NAPHCARE Commercial |
$1,114.29
|
| 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: Wellcare Medicare |
$742.86
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 62323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$742.86 |
| Max. Negotiated Rate |
$4,386.95 |
| 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 Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| 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: 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: NAPHCARE Commercial |
$1,114.29
|
| 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: Wellcare Medicare |
$742.86
|
|
|
Injection(s); Single or Multiple Trigger Points 20552
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
1188966
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$157.34 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$34.96
|
| Rate for Payer: Anthem Medicare Advantage |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.96
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$52.45
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: Quartz Medicare Advantage |
$34.96
|
| Rate for Payer: The Alliance Commercial |
$148.60
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.96
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$157.34
|
|
|
Injection(s); Single or Multiple Trigger Points, =>3 muscles 20553
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
3013705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$731.12 |
| Rate for Payer: Aetna Commercial |
$731.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| Rate for Payer: Aetna Managed Medicare |
$39.85
|
| Rate for Payer: Anthem Medicare Advantage |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.85
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$731.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.85
|
| Rate for Payer: Health EOS Commercial |
$700.34
|
| Rate for Payer: HFN Commercial |
$731.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.85
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: NAPHCARE Commercial |
$59.78
|
| Rate for Payer: Preferred Network Access Commercial |
$731.12
|
| Rate for Payer: Quartz Beloit One Network |
$338.62
|
| Rate for Payer: Quartz Commercial |
$438.67
|
| Rate for Payer: Quartz Medicare Advantage |
$39.85
|
| Rate for Payer: The Alliance Commercial |
$169.37
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.85
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: WPS Commercial |
$179.34
|
|
|
Injection(s); Single or Multiple Trigger Points, =>3 muscles 2055350
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 20553 50
|
| Hospital Charge Code |
5543183
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$1,467.18 |
| Rate for Payer: Aetna Commercial |
$1,467.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,467.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$926.64
|
| Rate for Payer: Health EOS Commercial |
$1,405.40
|
| Rate for Payer: HFN Commercial |
$1,467.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.98
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,467.18
|
| Rate for Payer: Quartz Beloit One Network |
$679.54
|
| Rate for Payer: Quartz Commercial |
$880.31
|
| Rate for Payer: The Alliance Commercial |
$772.20
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$1,143.90
|
|
|
Injection(s); Single Tendon Sheath 20551
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
1188965
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$260.83 |
| Rate for Payer: Aetna Commercial |
$260.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$32.21
|
| Rate for Payer: Anthem Medicare Advantage |
$32.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.21
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$260.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.21
|
| Rate for Payer: Health EOS Commercial |
$249.85
|
| Rate for Payer: HFN Commercial |
$260.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.21
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$48.31
|
| Rate for Payer: Preferred Network Access Commercial |
$260.83
|
| Rate for Payer: Quartz Beloit One Network |
$120.81
|
| Rate for Payer: Quartz Commercial |
$156.50
|
| Rate for Payer: Quartz Medicare Advantage |
$32.21
|
| Rate for Payer: The Alliance Commercial |
$136.89
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.21
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$144.94
|
|
|
Injection Therapeutic, Carpal Tunnel 20526
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
1188967
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$251.94 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$46.76
|
| Rate for Payer: Anthem Medicare Advantage |
$46.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.76
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.76
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.76
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$70.14
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| Rate for Payer: Quartz Medicare Advantage |
$46.76
|
| Rate for Payer: The Alliance Commercial |
$198.72
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.76
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$210.41
|
|
|
Injection Therapy of Veins 3647150
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
CPT 36471 50
|
| Hospital Charge Code |
3970712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$1,140.15 |
| Rate for Payer: Aetna Commercial |
$1,140.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.14
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,140.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.10
|
| Rate for Payer: Health EOS Commercial |
$1,092.15
|
| Rate for Payer: HFN Commercial |
$1,140.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.27
|
| Rate for Payer: Multiplan Commercial |
$960.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.15
|
| Rate for Payer: Quartz Beloit One Network |
$528.07
|
| Rate for Payer: Quartz Commercial |
$684.09
|
| Rate for Payer: The Alliance Commercial |
$600.08
|
| Rate for Payer: United Healthcare Medicaid |
$77.71
|
| Rate for Payer: WEA Trust Commercial |
$660.09
|
| Rate for Payer: WPS Commercial |
$888.93
|
|
|
INJECTION TREATMENT OF NERVE 64620
|
Professional
|
Both
|
$1,522.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
3015199
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.71 |
| Max. Negotiated Rate |
$1,503.74 |
| Rate for Payer: Aetna Commercial |
$1,503.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,361.28
|
| Rate for Payer: Aetna Managed Medicare |
$162.71
|
| Rate for Payer: Anthem Medicare Advantage |
$162.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.71
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cash Price |
$456.60
|
| Rate for Payer: Cigna Commercial |
$1,503.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.71
|
| Rate for Payer: Health EOS Commercial |
$1,440.42
|
| Rate for Payer: HFN Commercial |
$1,503.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$619.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$619.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.71
|
| Rate for Payer: Multiplan Commercial |
$1,266.30
|
| Rate for Payer: NAPHCARE Commercial |
$244.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.74
|
| Rate for Payer: Quartz Beloit One Network |
$696.47
|
| Rate for Payer: Quartz Commercial |
$902.24
|
| Rate for Payer: Quartz Medicare Advantage |
$162.71
|
| Rate for Payer: The Alliance Commercial |
$691.51
|
| Rate for Payer: United Healthcare Medicaid |
$201.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.71
|
| Rate for Payer: WEA Trust Commercial |
$870.58
|
| Rate for Payer: WPS Commercial |
$732.19
|
|
|
Injection Treatment of Nerve 6464050
|
Professional
|
Both
|
$2,525.00
|
|
|
Service Code
|
CPT 64640 50
|
| Hospital Charge Code |
3215484
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.27 |
| Max. Negotiated Rate |
$2,494.70 |
| Rate for Payer: Aetna Commercial |
$2,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,258.36
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cash Price |
$757.50
|
| Rate for Payer: Cigna Commercial |
$2,494.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,575.60
|
| Rate for Payer: Health EOS Commercial |
$2,389.66
|
| Rate for Payer: HFN Commercial |
$2,494.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$2,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,494.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,155.44
|
| Rate for Payer: Quartz Commercial |
$1,496.82
|
| Rate for Payer: The Alliance Commercial |
$1,313.00
|
| Rate for Payer: United Healthcare Medicaid |
$163.27
|
| Rate for Payer: WEA Trust Commercial |
$1,444.30
|
| Rate for Payer: WPS Commercial |
$1,945.01
|
|
|
Injection W/Image Spine Cerv/Thoracic 62321
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
5232806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.88 |
| Max. Negotiated Rate |
$1,238.95 |
| Rate for Payer: Aetna Commercial |
$1,238.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,121.58
|
| Rate for Payer: Aetna Managed Medicare |
$93.88
|
| Rate for Payer: Anthem Medicare Advantage |
$93.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.88
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,238.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.88
|
| Rate for Payer: Health EOS Commercial |
$1,186.79
|
| Rate for Payer: HFN Commercial |
$1,238.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.88
|
| Rate for Payer: Multiplan Commercial |
$1,043.33
|
| Rate for Payer: NAPHCARE Commercial |
$140.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,238.95
|
| Rate for Payer: Quartz Beloit One Network |
$573.83
|
| Rate for Payer: Quartz Commercial |
$743.37
|
| Rate for Payer: Quartz Medicare Advantage |
$93.88
|
| Rate for Payer: The Alliance Commercial |
$398.99
|
| Rate for Payer: United Healthcare Medicaid |
$200.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.88
|
| Rate for Payer: WEA Trust Commercial |
$717.29
|
| Rate for Payer: WPS Commercial |
$422.46
|
|
|
Injection W/Image Spine Lumbar/Sacral 62323
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
5232818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$871.42 |
| Rate for Payer: Aetna Commercial |
$871.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.86
|
| Rate for Payer: Aetna Managed Medicare |
$87.58
|
| Rate for Payer: Anthem Medicare Advantage |
$87.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.58
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna Commercial |
$871.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$197.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.58
|
| Rate for Payer: Health EOS Commercial |
$834.72
|
| Rate for Payer: HFN Commercial |
$871.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$733.82
|
| Rate for Payer: NAPHCARE Commercial |
$131.37
|
| Rate for Payer: Preferred Network Access Commercial |
$871.42
|
| Rate for Payer: Quartz Beloit One Network |
$403.60
|
| Rate for Payer: Quartz Commercial |
$522.85
|
| Rate for Payer: Quartz Medicare Advantage |
$87.58
|
| Rate for Payer: The Alliance Commercial |
$372.21
|
| Rate for Payer: United Healthcare Medicaid |
$197.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.58
|
| Rate for Payer: WEA Trust Commercial |
$504.50
|
| Rate for Payer: WPS Commercial |
$394.10
|
|
|
INJECTN NONCMPND SCLEROSANT MULTIPLE 36466
|
Professional
|
Both
|
$4,140.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
6181367
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,090.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,702.82
|
| Rate for Payer: Aetna Managed Medicare |
$123.73
|
| Rate for Payer: Anthem Medicare Advantage |
$123.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.73
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.73
|
| Rate for Payer: Health EOS Commercial |
$3,918.10
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$520.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.73
|
| Rate for Payer: Multiplan Commercial |
$3,444.48
|
| Rate for Payer: NAPHCARE Commercial |
$185.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,894.46
|
| Rate for Payer: Quartz Commercial |
$2,454.19
|
| Rate for Payer: Quartz Medicare Advantage |
$123.73
|
| Rate for Payer: The Alliance Commercial |
$525.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.73
|
| Rate for Payer: WEA Trust Commercial |
$2,368.08
|
| Rate for Payer: WPS Commercial |
$556.78
|
|
|
INJECTN NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN 36465
|
Professional
|
Both
|
$3,769.00
|
|
|
Service Code
|
CPT 36465
|
| Hospital Charge Code |
6181366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.67 |
| Max. Negotiated Rate |
$3,723.77 |
| Rate for Payer: Aetna Commercial |
$3,723.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,370.99
|
| Rate for Payer: Aetna Managed Medicare |
$97.67
|
| Rate for Payer: Anthem Medicare Advantage |
$97.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.67
|
| Rate for Payer: Cash Price |
$1,130.70
|
| Rate for Payer: Cash Price |
$1,130.70
|
| Rate for Payer: Cash Price |
$1,130.70
|
| Rate for Payer: Cigna Commercial |
$3,723.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,959.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.67
|
| Rate for Payer: Health EOS Commercial |
$3,566.98
|
| Rate for Payer: HFN Commercial |
$3,723.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$398.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.67
|
| Rate for Payer: Multiplan Commercial |
$3,135.81
|
| Rate for Payer: NAPHCARE Commercial |
$146.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,723.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,724.69
|
| Rate for Payer: Quartz Commercial |
$2,234.26
|
| Rate for Payer: Quartz Medicare Advantage |
$97.67
|
| Rate for Payer: The Alliance Commercial |
$415.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.67
|
| Rate for Payer: WEA Trust Commercial |
$2,155.87
|
| Rate for Payer: WPS Commercial |
$439.50
|
|
|
Inj Elbow Athrography
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$794.35 |
| Rate for Payer: Aetna Commercial |
$794.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$794.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$760.91
|
| Rate for Payer: HFN Commercial |
$794.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$235.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$794.35
|
| Rate for Payer: Quartz Beloit One Network |
$367.91
|
| Rate for Payer: Quartz Commercial |
$476.61
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$233.07
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: WPS Commercial |
$246.78
|
|
|
Inj Elbow Athrography
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.72 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$752.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.16
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$769.27
|
| Rate for Payer: Health EOS Commercial |
$744.18
|
| Rate for Payer: HFN Commercial |
$769.27
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: Preferred Network Access Commercial |
$769.27
|
| Rate for Payer: Quartz Beloit One Network |
$409.72
|
| Rate for Payer: Quartz Commercial |
$501.70
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: WPS Commercial |
$619.32
|
|
|
Inj Elbow Athrography
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.36 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$752.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Aetna Managed Medicare |
$234.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$543.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$401.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.16
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$769.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$744.18
|
| Rate for Payer: HFN Commercial |
$769.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.12
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: NAPHCARE Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$769.27
|
| Rate for Payer: Quartz Beloit One Network |
$409.72
|
| Rate for Payer: Quartz Commercial |
$543.50
|
| Rate for Payer: Quartz Medicare Advantage |
$501.70
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: WPS Commercial |
$619.32
|
|
|
Inj Enzyme Palmar Fascial Cord 20527
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
4374575
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$55.38
|
| Rate for Payer: Anthem Medicare Advantage |
$55.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.38
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.38
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.38
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$83.07
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$55.38
|
| Rate for Payer: The Alliance Commercial |
$235.37
|
| Rate for Payer: United Healthcare Medicaid |
$59.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.38
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$249.21
|
|
|
Inj for Knee Arthrography
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$495.33 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$606.53
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
Inj for Knee Arthrography
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$283.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$505.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.70
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.16
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$657.07
|
| Rate for Payer: Quartz Medicare Advantage |
$606.53
|
| Rate for Payer: The Alliance Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
Inj for Knee Arthrography
|
Professional
|
Both
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$444.79 |
| Max. Negotiated Rate |
$960.34 |
| Rate for Payer: Aetna Commercial |
$960.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$960.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$505.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.53
|
| Rate for Payer: Health EOS Commercial |
$919.90
|
| Rate for Payer: HFN Commercial |
$960.34
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$960.34
|
| Rate for Payer: Quartz Beloit One Network |
$444.79
|
| Rate for Payer: Quartz Commercial |
$576.20
|
| Rate for Payer: The Alliance Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
Inj Hip Arthrogram
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.04 |
| Max. Negotiated Rate |
$850.67 |
| Rate for Payer: Aetna Commercial |
$850.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Aetna Managed Medicare |
$56.04
|
| Rate for Payer: Anthem Medicare Advantage |
$56.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.04
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$850.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.04
|
| Rate for Payer: Health EOS Commercial |
$814.85
|
| Rate for Payer: HFN Commercial |
$850.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.04
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: NAPHCARE Commercial |
$84.05
|
| Rate for Payer: Preferred Network Access Commercial |
$850.67
|
| Rate for Payer: Quartz Beloit One Network |
$393.99
|
| Rate for Payer: Quartz Commercial |
$510.40
|
| Rate for Payer: Quartz Medicare Advantage |
$56.04
|
| Rate for Payer: The Alliance Commercial |
$238.15
|
| Rate for Payer: United Healthcare Medicaid |
$68.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.04
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$252.16
|
|
