|
MC Tobacco Counseling 3-10 Minutes G0436
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
2957679
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$43.58 |
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$10.55
|
| Rate for Payer: Anthem Medicare Advantage |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.55
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.55
|
| Rate for Payer: Health EOS Commercial |
$17.98
|
| Rate for Payer: HFN Commercial |
$18.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$15.82
|
| Rate for Payer: Preferred Network Access Commercial |
$18.77
|
| Rate for Payer: Quartz Beloit One Network |
$8.69
|
| Rate for Payer: Quartz Commercial |
$11.26
|
| Rate for Payer: Quartz Medicare Advantage |
$10.55
|
| Rate for Payer: The Alliance Commercial |
$25.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.55
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$29.00
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$9.02
|
| Rate for Payer: Anthem Medicare Advantage |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.02
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.02
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$13.53
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: Quartz Medicare Advantage |
$9.02
|
| Rate for Payer: The Alliance Commercial |
$24.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$15.78
|
|
|
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 |
$471.33 |
| Max. Negotiated Rate |
$1,017.64 |
| Rate for Payer: Aetna Commercial |
$1,017.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$1,017.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$535.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.72
|
| Rate for Payer: Health EOS Commercial |
$974.79
|
| Rate for Payer: HFN Commercial |
$1,017.64
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.64
|
| Rate for Payer: Quartz Beloit One Network |
$471.33
|
| Rate for Payer: Quartz Commercial |
$610.58
|
| Rate for Payer: The Alliance Commercial |
$535.60
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
Measles Antibody IgG
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Measles Antibody IgG
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Measles Antibody IgG
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
1043141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$175.86 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Measles Antibody, IgG & IgM
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$182.78 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$182.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$175.08
|
| Rate for Payer: HFN Commercial |
$182.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$182.78
|
| Rate for Payer: Quartz Beloit One Network |
$84.66
|
| Rate for Payer: Quartz Commercial |
$109.67
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Measles Antibody, IgG & IgM
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$144.30
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Measles Antibody, IgG & IgM
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
983319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Measles IgG
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Measles IgG
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Measles IgG
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494962
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Measles IgM
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Measles IgM
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Measles IgM
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
4494963
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Measles IgM Antibody
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$142.27 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$142.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$136.28
|
| Rate for Payer: HFN Commercial |
$142.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$142.27
|
| Rate for Payer: Quartz Beloit One Network |
$65.89
|
| Rate for Payer: Quartz Commercial |
$85.36
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Measles IgM Antibody
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Measles IgM Antibody
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
2942949
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Measles PCR, WSLH
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$320.11 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$320.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$306.63
|
| Rate for Payer: HFN Commercial |
$320.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$320.11
|
| Rate for Payer: Quartz Beloit One Network |
$148.26
|
| Rate for Payer: Quartz Commercial |
$192.07
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Measles PCR, WSLH
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$219.02
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
Measles PCR, WSLH
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4464958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$202.18
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
MEASUREMENT CELL 1/2X1/2 TMC50
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
2965300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Aetna Managed Medicare |
$278.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$645.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.81
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.90
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: NAPHCARE Commercial |
$595.92
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$645.58
|
| Rate for Payer: Quartz Medicare Advantage |
$595.92
|
| Rate for Payer: The Alliance Commercial |
$496.60
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
|
MEASUREMENT CELL 1/2X1/2 TMC50
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
2965300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.67 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$595.92
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
|
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 |
$278.10 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Aetna Managed Medicare |
$278.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$645.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.81
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.90
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: NAPHCARE Commercial |
$595.92
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$645.58
|
| Rate for Payer: Quartz Medicare Advantage |
$595.92
|
| Rate for Payer: The Alliance Commercial |
$496.60
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
|
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 |
$486.67 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$595.92
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
