|
Mix PT 1 Hour
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$105.72 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$19.63
|
|
|
Mix PT 1 Hour
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Mix PT Immed
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$105.72 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$19.63
|
|
|
Mix PT Immed
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: United Healthcare PPO |
$83.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Mix PT Immed
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$66.77
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Mix PTT 1 Hour
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
Mix PTT 1 Hour
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Mix PTT 1 Hour
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Mix PTT Immed
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Mix PTT Immed
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Mix PTT Immed
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
1050822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
MLC Device For IMRT Design and CBN
|
Facility
|
IP
|
$3,098.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
3040392
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,578.74 |
| Max. Negotiated Rate |
$2,964.17 |
| Rate for Payer: Aetna Commercial |
$2,899.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.62
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$2,964.17
|
| Rate for Payer: Health EOS Commercial |
$2,867.51
|
| Rate for Payer: HFN Commercial |
$2,964.17
|
| Rate for Payer: Multiplan Commercial |
$2,577.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.74
|
| Rate for Payer: Quartz Commercial |
$1,933.15
|
| Rate for Payer: WEA Trust Commercial |
$1,772.06
|
| Rate for Payer: WPS Commercial |
$2,386.39
|
|
|
MLC Device For IMRT Design and CBN
|
Facility
|
OP
|
$3,098.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
3040392
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$2,964.17 |
| Rate for Payer: Aetna Commercial |
$2,899.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.85
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cigna Commercial |
$2,964.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,803.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$2,867.51
|
| Rate for Payer: HFN Commercial |
$2,964.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$2,577.54
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.74
|
| Rate for Payer: Quartz Commercial |
$2,094.25
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$2,416.44
|
| Rate for Payer: WEA Trust Commercial |
$1,772.06
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$2,386.39
|
|
|
MLH1
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81292
|
| Hospital Charge Code |
5542923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$340.41 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$416.83
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
MLH1
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81292
|
| Hospital Charge Code |
5542923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$340.41 |
| Max. Negotiated Rate |
$2,809.66 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$702.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,634.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,229.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,166.01
|
| Rate for Payer: Anthem Medicare Advantage |
$702.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$702.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$702.42
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$702.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$702.42
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,612.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$702.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$702.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$702.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$702.42
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.62
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$451.57
|
| Rate for Payer: Quartz Medicare Advantage |
$702.42
|
| Rate for Payer: The Alliance Commercial |
$2,809.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$702.42
|
| Rate for Payer: United Healthcare PPO |
$521.04
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: Wellcare Medicare |
$702.42
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
MLH1
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81292
|
| Hospital Charge Code |
5542923
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$305.68 |
| Max. Negotiated Rate |
$3,090.63 |
| Rate for Payer: Aetna Commercial |
$659.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$702.42
|
| Rate for Payer: Anthem Medicare Advantage |
$702.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$702.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$702.42
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$659.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.42
|
| Rate for Payer: Health EOS Commercial |
$632.20
|
| Rate for Payer: HFN Commercial |
$659.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,479.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,479.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$702.42
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.62
|
| Rate for Payer: Preferred Network Access Commercial |
$659.98
|
| Rate for Payer: Quartz Beloit One Network |
$305.68
|
| Rate for Payer: Quartz Commercial |
$395.99
|
| Rate for Payer: Quartz Medicare Advantage |
$702.42
|
| Rate for Payer: The Alliance Commercial |
$2,774.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$702.42
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$3,090.63
|
|
|
MLH1 Dup/Del
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81294
|
| Hospital Charge Code |
5542924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$340.41 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$416.83
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
MLH1 Dup/Del
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81294
|
| Hospital Charge Code |
5542924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$841.98 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$210.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$789.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.42
|
| Rate for Payer: Anthem Medicare Advantage |
$210.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.50
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$315.74
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$451.57
|
| Rate for Payer: Quartz Medicare Advantage |
$210.50
|
| Rate for Payer: The Alliance Commercial |
$841.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.50
|
| Rate for Payer: United Healthcare PPO |
$521.04
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: Wellcare Medicare |
$210.50
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
MLH1 Dup/Del
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81294
|
| Hospital Charge Code |
5542924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$659.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$210.50
|
| Rate for Payer: Anthem Medicare Advantage |
$210.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.50
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$659.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$632.20
|
| Rate for Payer: HFN Commercial |
$659.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$743.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$315.74
|
| Rate for Payer: Preferred Network Access Commercial |
$659.98
|
| Rate for Payer: Quartz Beloit One Network |
$305.68
|
| Rate for Payer: Quartz Commercial |
$395.99
|
| Rate for Payer: Quartz Medicare Advantage |
$210.50
|
| Rate for Payer: The Alliance Commercial |
$831.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.50
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$926.18
|
|
|
MMR Vaccine, SC 90707
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
3455572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$60.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.64
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.02
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$130.42
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$141.28
|
| Rate for Payer: Quartz Medicare Advantage |
$130.42
|
| Rate for Payer: The Alliance Commercial |
$108.68
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
MMR Vaccine, SC 90707
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
3455572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$206.49 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.42
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.16
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: The Alliance Commercial |
$108.68
|
| Rate for Payer: United Healthcare Medicaid |
$101.92
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
MMR Vaccine, SC 90707
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
3455572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.51 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
MMR Vaccine, SC 90707VFC
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
5176606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
MMR Vaccine, SC 90707VFC
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
5176606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$11.44
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
MMR Vaccine, SC 90707VFC
|
Professional
|
Both
|
$80.83
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
5176606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$142.16 |
| Rate for Payer: Aetna Commercial |
$79.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.29
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cash Price |
$24.25
|
| Rate for Payer: Cigna Commercial |
$79.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.44
|
| Rate for Payer: Health EOS Commercial |
$76.50
|
| Rate for Payer: HFN Commercial |
$79.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.16
|
| Rate for Payer: Multiplan Commercial |
$67.25
|
| Rate for Payer: Preferred Network Access Commercial |
$79.86
|
| Rate for Payer: Quartz Beloit One Network |
$36.99
|
| Rate for Payer: Quartz Commercial |
$47.92
|
| Rate for Payer: The Alliance Commercial |
$42.03
|
| Rate for Payer: United Healthcare Medicaid |
$101.92
|
| Rate for Payer: WEA Trust Commercial |
$46.23
|
| Rate for Payer: WPS Commercial |
$62.26
|
|
