|
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 |
$193.28 |
| Max. Negotiated Rate |
$1,445.90 |
| Rate for Payer: Aetna Commercial |
$1,445.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,308.92
|
| 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 |
$1,445.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$913.20
|
| Rate for Payer: Health EOS Commercial |
$1,385.02
|
| Rate for Payer: HFN Commercial |
$1,445.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$595.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$595.48
|
| Rate for Payer: Multiplan Commercial |
$1,217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.90
|
| Rate for Payer: Quartz Beloit One Network |
$669.68
|
| Rate for Payer: Quartz Commercial |
$867.54
|
| Rate for Payer: The Alliance Commercial |
$761.00
|
| Rate for Payer: United Healthcare Medicaid |
$193.28
|
| Rate for Payer: WEA Trust Commercial |
$837.10
|
| Rate for Payer: WPS Commercial |
$1,127.35
|
|
|
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 |
$156.99 |
| Max. Negotiated Rate |
$2,398.75 |
| Rate for Payer: Aetna Commercial |
$2,398.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,171.50
|
| 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 |
$2,398.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,515.00
|
| Rate for Payer: Health EOS Commercial |
$2,297.75
|
| Rate for Payer: HFN Commercial |
$2,398.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.48
|
| Rate for Payer: Multiplan Commercial |
$2,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,398.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,111.00
|
| Rate for Payer: Quartz Commercial |
$1,439.25
|
| Rate for Payer: The Alliance Commercial |
$1,262.50
|
| Rate for Payer: United Healthcare Medicaid |
$156.99
|
| Rate for Payer: WEA Trust Commercial |
$1,388.75
|
| Rate for Payer: WPS Commercial |
$1,870.27
|
|
|
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 |
$192.81 |
| Max. Negotiated Rate |
$1,191.30 |
| Rate for Payer: Aetna Commercial |
$1,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| 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 |
$1,191.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$752.40
|
| Rate for Payer: Health EOS Commercial |
$1,141.14
|
| Rate for Payer: HFN Commercial |
$1,191.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.13
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,191.30
|
| Rate for Payer: Quartz Beloit One Network |
$551.76
|
| Rate for Payer: Quartz Commercial |
$714.78
|
| Rate for Payer: The Alliance Commercial |
$627.00
|
| Rate for Payer: United Healthcare Medicaid |
$192.81
|
| Rate for Payer: WEA Trust Commercial |
$689.70
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
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 |
$189.62 |
| Max. Negotiated Rate |
$837.90 |
| Rate for Payer: Aetna Commercial |
$837.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$758.52
|
| 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 |
$837.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.20
|
| Rate for Payer: Health EOS Commercial |
$802.62
|
| Rate for Payer: HFN Commercial |
$837.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.64
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Preferred Network Access Commercial |
$837.90
|
| Rate for Payer: Quartz Beloit One Network |
$388.08
|
| Rate for Payer: Quartz Commercial |
$502.74
|
| Rate for Payer: The Alliance Commercial |
$441.00
|
| Rate for Payer: United Healthcare Medicaid |
$189.62
|
| Rate for Payer: WEA Trust Commercial |
$485.10
|
| Rate for Payer: WPS Commercial |
$653.30
|
|
|
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 |
$500.24 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Aetna Commercial |
$3,933.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,560.40
|
| 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 |
$3,933.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,070.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,484.00
|
| Rate for Payer: Health EOS Commercial |
$3,767.40
|
| Rate for Payer: HFN Commercial |
$3,933.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$500.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$500.24
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,933.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,821.60
|
| Rate for Payer: Quartz Commercial |
$2,359.80
|
| Rate for Payer: The Alliance Commercial |
$2,070.00
|
| Rate for Payer: WEA Trust Commercial |
$2,277.00
|
| Rate for Payer: WPS Commercial |
$3,066.50
|
|
|
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 |
$383.61 |
| Max. Negotiated Rate |
$3,580.55 |
| Rate for Payer: Aetna Commercial |
$3,580.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,241.34
|
| 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 |
$3,580.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,884.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,261.40
|
| Rate for Payer: Health EOS Commercial |
$3,429.79
|
| Rate for Payer: HFN Commercial |
$3,580.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$383.61
|
| Rate for Payer: Multiplan Commercial |
$3,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,658.36
|
| Rate for Payer: Quartz Commercial |
$2,148.33
|
| Rate for Payer: The Alliance Commercial |
$1,884.50
|
| Rate for Payer: WEA Trust Commercial |
$2,072.95
|
| Rate for Payer: WPS Commercial |
$2,791.70
|
|
|
Inj Elbow Athrography
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$723.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.44
|
| Rate for Payer: Aetna Managed Medicare |
$225.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$522.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$385.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.12
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$739.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$715.56
|
| Rate for Payer: HFN Commercial |
$739.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.00
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: NAPHCARE Commercial |
$482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$739.68
|
| Rate for Payer: Quartz Beloit One Network |
$393.96
|
| Rate for Payer: Quartz Commercial |
$522.60
|
| Rate for Payer: Quartz Medicare Advantage |
$482.40
|
| Rate for Payer: The Alliance Commercial |
$3,216.00
|
| Rate for Payer: WEA Trust Commercial |
$442.20
|
| Rate for Payer: WPS Commercial |
$595.52
|
|
|
Inj Elbow Athrography
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$763.80 |
| Rate for Payer: Aetna Commercial |
$763.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.44
|
| 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 |
$763.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$482.40
|
| Rate for Payer: Health EOS Commercial |
$731.64
|
| Rate for Payer: HFN Commercial |
$763.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$763.80
|
| Rate for Payer: Quartz Beloit One Network |
$353.76
|
| Rate for Payer: Quartz Commercial |
$458.28
|
| Rate for Payer: The Alliance Commercial |
$402.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$442.20
|
| Rate for Payer: WPS Commercial |
$595.52
|
|
|
Inj Elbow Athrography
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
3072672
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.96 |
| Max. Negotiated Rate |
$739.68 |
| Rate for Payer: Aetna Commercial |
$723.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$691.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$426.12
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$739.68
|
| Rate for Payer: Health EOS Commercial |
$715.56
|
| Rate for Payer: HFN Commercial |
$739.68
|
| Rate for Payer: Multiplan Commercial |
$643.20
|
| Rate for Payer: NAPHCARE Commercial |
$482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$739.68
|
| Rate for Payer: Quartz Beloit One Network |
$393.96
|
| Rate for Payer: Quartz Commercial |
$482.40
|
| Rate for Payer: WEA Trust Commercial |
$442.20
|
| Rate for Payer: WPS Commercial |
$595.52
|
|
|
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 |
$57.24 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| 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 |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.60
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| Rate for Payer: HFN Commercial |
$357.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.22
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: The Alliance Commercial |
$188.00
|
| Rate for Payer: United Healthcare Medicaid |
$57.24
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
Inj for Knee Arthrography
|
Facility
|
OP
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$3,888.00 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.93
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$3,888.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
Inj for Knee Arthrography
|
Professional
|
Both
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$427.68 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna Commercial |
$923.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$923.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$486.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.20
|
| Rate for Payer: Health EOS Commercial |
$884.52
|
| Rate for Payer: HFN Commercial |
$923.40
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$923.40
|
| Rate for Payer: Quartz Beloit One Network |
$427.68
|
| Rate for Payer: Quartz Commercial |
$554.04
|
| Rate for Payer: The Alliance Commercial |
$486.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
Inj for Knee Arthrography
|
Facility
|
IP
|
$972.00
|
|
| Hospital Charge Code |
3791450
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
Inj Hip Arthrogram
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.89 |
| Max. Negotiated Rate |
$817.95 |
| Rate for Payer: Aetna Commercial |
$817.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.46
|
| 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 |
$817.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.60
|
| Rate for Payer: Health EOS Commercial |
$783.51
|
| Rate for Payer: HFN Commercial |
$817.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$817.95
|
| Rate for Payer: Quartz Beloit One Network |
$378.84
|
| Rate for Payer: Quartz Commercial |
$490.77
|
| Rate for Payer: The Alliance Commercial |
$430.50
|
| Rate for Payer: United Healthcare Medicaid |
$65.89
|
| Rate for Payer: WEA Trust Commercial |
$473.55
|
| Rate for Payer: WPS Commercial |
$637.74
|
|
|
Inj Hip Arthrogram
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$774.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.46
|
| Rate for Payer: Aetna Managed Medicare |
$241.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$413.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.33
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$792.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$766.29
|
| Rate for Payer: HFN Commercial |
$792.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.75
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: NAPHCARE Commercial |
$516.60
|
| Rate for Payer: Preferred Network Access Commercial |
$792.12
|
| Rate for Payer: Quartz Beloit One Network |
$421.89
|
| Rate for Payer: Quartz Commercial |
$559.65
|
| Rate for Payer: Quartz Medicare Advantage |
$516.60
|
| Rate for Payer: The Alliance Commercial |
$3,444.00
|
| Rate for Payer: WEA Trust Commercial |
$473.55
|
| Rate for Payer: WPS Commercial |
$637.74
|
|
|
Inj Hip Arthrogram
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$421.89 |
| Max. Negotiated Rate |
$792.12 |
| Rate for Payer: Aetna Commercial |
$774.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.33
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$792.12
|
| Rate for Payer: Health EOS Commercial |
$766.29
|
| Rate for Payer: HFN Commercial |
$792.12
|
| Rate for Payer: Multiplan Commercial |
$688.80
|
| Rate for Payer: NAPHCARE Commercial |
$516.60
|
| Rate for Payer: Preferred Network Access Commercial |
$792.12
|
| Rate for Payer: Quartz Beloit One Network |
$421.89
|
| Rate for Payer: Quartz Commercial |
$516.60
|
| Rate for Payer: WEA Trust Commercial |
$473.55
|
| Rate for Payer: WPS Commercial |
$637.74
|
|
|
Inj Hysterosalpingogram
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.24 |
| Max. Negotiated Rate |
$4,932.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Aetna Managed Medicare |
$345.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$924.75
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$801.45
|
| Rate for Payer: Quartz Medicare Advantage |
$739.80
|
| Rate for Payer: The Alliance Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
Inj Hysterosalpingogram
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.17 |
| Max. Negotiated Rate |
$1,134.36 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.49
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,134.36
|
| Rate for Payer: Health EOS Commercial |
$1,097.37
|
| Rate for Payer: HFN Commercial |
$1,134.36
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: NAPHCARE Commercial |
$739.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.36
|
| Rate for Payer: Quartz Beloit One Network |
$604.17
|
| Rate for Payer: Quartz Commercial |
$739.80
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
Inj Hysterosalpingogram
|
Professional
|
Both
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.46 |
| Max. Negotiated Rate |
$1,171.35 |
| Rate for Payer: Aetna Commercial |
$1,171.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.38
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,171.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.80
|
| Rate for Payer: Health EOS Commercial |
$1,122.03
|
| Rate for Payer: HFN Commercial |
$1,171.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$189.70
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,171.35
|
| Rate for Payer: Quartz Beloit One Network |
$542.52
|
| Rate for Payer: Quartz Commercial |
$702.81
|
| Rate for Payer: The Alliance Commercial |
$616.50
|
| Rate for Payer: United Healthcare Medicaid |
$112.46
|
| Rate for Payer: WEA Trust Commercial |
$678.15
|
| Rate for Payer: WPS Commercial |
$913.28
|
|
|
Inj Knee Arthrogram
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.43 |
| Max. Negotiated Rate |
$994.65 |
| Rate for Payer: Aetna Commercial |
$994.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.42
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$994.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.20
|
| Rate for Payer: Health EOS Commercial |
$952.77
|
| Rate for Payer: HFN Commercial |
$994.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.29
|
| Rate for Payer: Multiplan Commercial |
$837.60
|
| Rate for Payer: Preferred Network Access Commercial |
$994.65
|
| Rate for Payer: Quartz Beloit One Network |
$460.68
|
| Rate for Payer: Quartz Commercial |
$596.79
|
| Rate for Payer: The Alliance Commercial |
$523.50
|
| Rate for Payer: United Healthcare Medicaid |
$111.43
|
| Rate for Payer: WEA Trust Commercial |
$575.85
|
| Rate for Payer: WPS Commercial |
$775.51
|
|
|
Inj Knee Arthrogram
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$513.03 |
| Max. Negotiated Rate |
$963.24 |
| Rate for Payer: Aetna Commercial |
$942.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.91
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$963.24
|
| Rate for Payer: Health EOS Commercial |
$931.83
|
| Rate for Payer: HFN Commercial |
$963.24
|
| Rate for Payer: Multiplan Commercial |
$837.60
|
| Rate for Payer: NAPHCARE Commercial |
$628.20
|
| Rate for Payer: Preferred Network Access Commercial |
$963.24
|
| Rate for Payer: Quartz Beloit One Network |
$513.03
|
| Rate for Payer: Quartz Commercial |
$628.20
|
| Rate for Payer: WEA Trust Commercial |
$575.85
|
| Rate for Payer: WPS Commercial |
$775.51
|
|
|
Inj Knee Arthrogram
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$942.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$900.42
|
| Rate for Payer: Aetna Managed Medicare |
$293.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.91
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$963.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$931.83
|
| Rate for Payer: HFN Commercial |
$963.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.25
|
| Rate for Payer: Multiplan Commercial |
$837.60
|
| Rate for Payer: NAPHCARE Commercial |
$628.20
|
| Rate for Payer: Preferred Network Access Commercial |
$963.24
|
| Rate for Payer: Quartz Beloit One Network |
$513.03
|
| Rate for Payer: Quartz Commercial |
$680.55
|
| Rate for Payer: Quartz Medicare Advantage |
$628.20
|
| Rate for Payer: The Alliance Commercial |
$4,188.00
|
| Rate for Payer: WEA Trust Commercial |
$575.85
|
| Rate for Payer: WPS Commercial |
$775.51
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$397.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.76
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$563.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$544.68
|
| Rate for Payer: HFN Commercial |
$563.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$563.04
|
| Rate for Payer: Quartz Beloit One Network |
$299.88
|
| Rate for Payer: Quartz Commercial |
$397.80
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$459.00
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$299.88 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.36
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$563.04
|
| Rate for Payer: Health EOS Commercial |
$544.68
|
| Rate for Payer: HFN Commercial |
$563.04
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: NAPHCARE Commercial |
$367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$563.04
|
| Rate for Payer: Quartz Beloit One Network |
$299.88
|
| Rate for Payer: Quartz Commercial |
$367.20
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
