|
MD INR TEST REVIEW INTER MGMT G0250
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
6041642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$41.86
|
| Rate for Payer: HFN Commercial |
$43.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$43.70
|
| Rate for Payer: Quartz Beloit One Network |
$20.24
|
| Rate for Payer: Quartz Commercial |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.63
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
MD Work/Medical Disability Eval 99455
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 99455
|
| Hospital Charge Code |
3005591
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$453.20 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna Commercial |
$978.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$978.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$515.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.00
|
| Rate for Payer: Health EOS Commercial |
$937.30
|
| Rate for Payer: HFN Commercial |
$978.50
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$978.50
|
| Rate for Payer: Quartz Beloit One Network |
$453.20
|
| Rate for Payer: Quartz Commercial |
$587.10
|
| Rate for Payer: The Alliance Commercial |
$515.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
Measles Antibody IgG
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Measles Antibody IgG
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.80
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$169.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: The Alliance Commercial |
$89.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Measles Antibody IgG
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Dean Health Medicaid |
$13.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.31
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$13.31
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Measles Antibody, IgG & IgM
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna Commercial |
$175.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$175.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.00
|
| Rate for Payer: Health EOS Commercial |
$168.35
|
| Rate for Payer: HFN Commercial |
$175.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$175.75
|
| Rate for Payer: Quartz Beloit One Network |
$81.40
|
| Rate for Payer: Quartz Commercial |
$105.45
|
| Rate for Payer: The Alliance Commercial |
$92.50
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Measles Antibody, IgG & IgM
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$111.00
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Measles Antibody, IgG & IgM
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.53
|
| Rate for Payer: Dean Health Medicaid |
$13.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$120.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$138.75
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$13.31
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Measles IgG
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgG
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Dean Health Medicaid |
$13.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.31
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$13.31
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgG
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.60
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: HFN Commercial |
$105.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: The Alliance Commercial |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgM
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.60
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: HFN Commercial |
$105.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: The Alliance Commercial |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Dean Health Medicaid |
$13.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.31
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$13.31
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Measles IgM Antibody
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.58
|
| Rate for Payer: Dean Health Medicaid |
$13.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$13.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.31
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$13.31
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Measles IgM Antibody
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Measles IgM Antibody
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.40
|
| Rate for Payer: Health EOS Commercial |
$131.04
|
| Rate for Payer: HFN Commercial |
$136.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$136.80
|
| Rate for Payer: Quartz Beloit One Network |
$63.36
|
| Rate for Payer: Quartz Commercial |
$82.08
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Measles PCR, WSLH
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Measles PCR, WSLH
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.31
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$210.60
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
Measles PCR, WSLH
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.40
|
| Rate for Payer: Health EOS Commercial |
$294.84
|
| Rate for Payer: HFN Commercial |
$307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: Preferred Network Access Commercial |
$307.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.56
|
| Rate for Payer: Quartz Commercial |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
MEASUREMENT CELL 1/2X1/2 TMC50
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
2965300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$3,820.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.30
|
| Rate for Payer: Aetna Managed Medicare |
$267.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.42
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.25
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$620.75
|
| Rate for Payer: Quartz Medicare Advantage |
$573.00
|
| Rate for Payer: The Alliance Commercial |
$3,820.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
MEASUREMENT CELL 1/2X1/2 TMC50
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
2965300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.95 |
| Max. Negotiated Rate |
$878.60 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$573.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
MEASUREMENT TRI-OPTIC CELL 3/8 X 3/8 IN (0.95CM X 0.95CM) TMC38
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
2965301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$3,820.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.30
|
| Rate for Payer: Aetna Managed Medicare |
$267.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.42
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.25
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$620.75
|
| Rate for Payer: Quartz Medicare Advantage |
$573.00
|
| Rate for Payer: The Alliance Commercial |
$3,820.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
MEASUREMENT TRI-OPTIC CELL 3/8 X 3/8 IN (0.95CM X 0.95CM) TMC38
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
2965301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.95 |
| Max. Negotiated Rate |
$878.60 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.15
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$878.60
|
| Rate for Payer: Health EOS Commercial |
$849.95
|
| Rate for Payer: HFN Commercial |
$878.60
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$878.60
|
| Rate for Payer: Quartz Beloit One Network |
$467.95
|
| Rate for Payer: Quartz Commercial |
$573.00
|
| Rate for Payer: WEA Trust Commercial |
$525.25
|
| Rate for Payer: WPS Commercial |
$707.37
|
|
|
MEASUREMENT WIRE 1.1MM CALIBRATED AR-9938-04
|
Facility
|
OP
|
$2,291.55
|
|
| Hospital Charge Code |
6252128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.63 |
| Max. Negotiated Rate |
$9,166.20 |
| Rate for Payer: Aetna Commercial |
$2,062.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,970.73
|
| Rate for Payer: Aetna Managed Medicare |
$641.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,489.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.52
|
| Rate for Payer: Cash Price |
$687.46
|
| Rate for Payer: Cigna Commercial |
$2,108.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,282.35
|
| Rate for Payer: Health EOS Commercial |
$2,039.48
|
| Rate for Payer: HFN Commercial |
$2,108.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,718.66
|
| Rate for Payer: Multiplan Commercial |
$1,833.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,108.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.86
|
| Rate for Payer: Quartz Commercial |
$1,489.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.93
|
| Rate for Payer: The Alliance Commercial |
$9,166.20
|
| Rate for Payer: WEA Trust Commercial |
$1,260.35
|
| Rate for Payer: WPS Commercial |
$1,697.35
|
|
