|
Morphine Sulfate 2mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.13
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$11.59
|
|
|
Morphine Sulfate 4mg carpuject [Med]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
Morphine Sulfate 4mg carpuject [Med]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
2974903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.13
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$12.65
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$11.59
|
|
|
Morphometric Analysis, BCR
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,098.19 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Aetna Commercial |
$2,017.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,927.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.84
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,061.90
|
| Rate for Payer: Health EOS Commercial |
$1,994.67
|
| Rate for Payer: HFN Commercial |
$2,061.90
|
| Rate for Payer: Multiplan Commercial |
$1,792.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,061.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.19
|
| Rate for Payer: Quartz Commercial |
$1,344.72
|
| Rate for Payer: WEA Trust Commercial |
$1,232.66
|
| Rate for Payer: WPS Commercial |
$1,660.00
|
|
|
Morphometric Analysis, BCR
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$2,129.14 |
| Rate for Payer: Aetna Commercial |
$2,129.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,927.43
|
| Rate for Payer: Aetna Managed Medicare |
$146.01
|
| Rate for Payer: Anthem Commercial |
$79.68
|
| Rate for Payer: Anthem Medicare Advantage |
$146.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.01
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,129.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,120.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.01
|
| Rate for Payer: Health EOS Commercial |
$2,039.49
|
| Rate for Payer: HFN Commercial |
$2,129.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.01
|
| Rate for Payer: Multiplan Commercial |
$1,792.96
|
| Rate for Payer: NAPHCARE Commercial |
$219.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,129.14
|
| Rate for Payer: Quartz Beloit One Network |
$986.13
|
| Rate for Payer: Quartz Commercial |
$1,277.48
|
| Rate for Payer: Quartz Medicare Advantage |
$146.01
|
| Rate for Payer: The Alliance Commercial |
$576.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.01
|
| Rate for Payer: WEA Trust Commercial |
$1,232.66
|
| Rate for Payer: WPS Commercial |
$642.42
|
|
|
Morphometric Analysis, BCR
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
2776840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$377.23 |
| Max. Negotiated Rate |
$2,061.90 |
| Rate for Payer: Aetna Commercial |
$2,017.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,927.43
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,187.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$2,061.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$1,994.67
|
| Rate for Payer: HFN Commercial |
$2,061.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$1,792.96
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,061.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.19
|
| Rate for Payer: Quartz Commercial |
$1,456.78
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$1,680.90
|
| Rate for Payer: WEA Trust Commercial |
$1,232.66
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$1,660.00
|
|
|
MORTON'S NEUROMA, EXCISION
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
MORTON'S NEUROMA, EXCISION
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
Motor&/sens 11-12 nrv cnd test 95912
|
Professional
|
Both
|
$3,640.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
3149527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$208.71 |
| Max. Negotiated Rate |
$3,596.32 |
| Rate for Payer: Aetna Commercial |
$3,596.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,255.62
|
| Rate for Payer: Aetna Managed Medicare |
$255.03
|
| Rate for Payer: Anthem Medicare Advantage |
$255.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$255.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$255.03
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$3,596.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.03
|
| Rate for Payer: Health EOS Commercial |
$3,444.90
|
| Rate for Payer: HFN Commercial |
$3,596.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$932.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$932.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$255.03
|
| Rate for Payer: Multiplan Commercial |
$3,028.48
|
| Rate for Payer: NAPHCARE Commercial |
$382.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,596.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,665.66
|
| Rate for Payer: Quartz Commercial |
$2,157.79
|
| Rate for Payer: Quartz Medicare Advantage |
$255.03
|
| Rate for Payer: The Alliance Commercial |
$637.57
|
| Rate for Payer: United Healthcare Medicaid |
$208.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.03
|
| Rate for Payer: WEA Trust Commercial |
$2,082.08
|
| Rate for Payer: WPS Commercial |
$1,020.12
|
|
|
Motor&/sens 11-12 nrv cnd test 9591226
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
CPT 95912 26
|
| Hospital Charge Code |
3850015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$1,458.29 |
| Rate for Payer: Aetna Commercial |
$1,458.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.13
|
| Rate for Payer: Aetna Managed Medicare |
$159.31
|
| Rate for Payer: Anthem Medicare Advantage |
$159.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.31
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Cigna Commercial |
$1,458.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.31
|
| Rate for Payer: Health EOS Commercial |
$1,396.89
|
| Rate for Payer: HFN Commercial |
$1,458.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.31
|
| Rate for Payer: Multiplan Commercial |
$1,228.03
|
| Rate for Payer: NAPHCARE Commercial |
$238.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.29
|
| Rate for Payer: Quartz Beloit One Network |
$675.42
|
| Rate for Payer: Quartz Commercial |
$874.97
|
| Rate for Payer: Quartz Medicare Advantage |
$159.31
|
| Rate for Payer: The Alliance Commercial |
$398.27
|
| Rate for Payer: United Healthcare Medicaid |
$125.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.31
|
| Rate for Payer: WEA Trust Commercial |
$844.27
|
| Rate for Payer: WPS Commercial |
$637.23
|
|
|
Motor&/sens 1-2 nrv cndj tst 95907
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
CPT 95907
|
| Hospital Charge Code |
3119366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$1,205.36 |
| Rate for Payer: Aetna Commercial |
$1,205.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.17
|
| Rate for Payer: Aetna Managed Medicare |
$94.14
|
| Rate for Payer: Anthem Medicare Advantage |
$94.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.14
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,205.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.14
|
| Rate for Payer: Health EOS Commercial |
$1,154.61
|
| Rate for Payer: HFN Commercial |
$1,205.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$338.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.14
|
| Rate for Payer: Multiplan Commercial |
$1,015.04
|
| Rate for Payer: NAPHCARE Commercial |
$141.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,205.36
|
| Rate for Payer: Quartz Beloit One Network |
$558.27
|
| Rate for Payer: Quartz Commercial |
$723.22
|
| Rate for Payer: Quartz Medicare Advantage |
$94.14
|
| Rate for Payer: The Alliance Commercial |
$235.35
|
| Rate for Payer: United Healthcare Medicaid |
$75.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.14
|
| Rate for Payer: WEA Trust Commercial |
$697.84
|
| Rate for Payer: WPS Commercial |
$376.56
|
|
|
Motor&/sens 1-2 nrv cndj tst 9590726
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
CPT 95907 26
|
| Hospital Charge Code |
3333546
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$489.06 |
| Rate for Payer: Aetna Commercial |
$489.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Aetna Managed Medicare |
$53.77
|
| Rate for Payer: Anthem Medicare Advantage |
$53.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.77
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$489.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.77
|
| Rate for Payer: Health EOS Commercial |
$468.47
|
| Rate for Payer: HFN Commercial |
$489.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.77
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: NAPHCARE Commercial |
$80.65
|
| Rate for Payer: Preferred Network Access Commercial |
$489.06
|
| Rate for Payer: Quartz Beloit One Network |
$226.51
|
| Rate for Payer: Quartz Commercial |
$293.44
|
| Rate for Payer: Quartz Medicare Advantage |
$53.77
|
| Rate for Payer: The Alliance Commercial |
$134.42
|
| Rate for Payer: United Healthcare Medicaid |
$41.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.77
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$215.07
|
|
|
Motor&/sens 3-4 nrv cndj tst 95908
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 95908
|
| Hospital Charge Code |
3103304
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.39 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$118.23
|
| Rate for Payer: Anthem Medicare Advantage |
$118.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.23
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.23
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$427.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.23
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$177.34
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$118.23
|
| Rate for Payer: The Alliance Commercial |
$295.57
|
| Rate for Payer: United Healthcare Medicaid |
$93.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.23
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$472.91
|
|
|
Motor&/sens 3-4 nrv cndj tst 9590826
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 95908 26
|
| Hospital Charge Code |
3147573
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$67.54
|
| Rate for Payer: Anthem Medicare Advantage |
$67.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.54
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.54
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.54
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$101.31
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$67.54
|
| Rate for Payer: The Alliance Commercial |
$168.84
|
| Rate for Payer: United Healthcare Medicaid |
$52.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.54
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$270.15
|
|
|
Motor&/sens 5-6 nrv cndj tst 95909
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
CPT 95909
|
| Hospital Charge Code |
3127524
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$111.83 |
| Max. Negotiated Rate |
$1,553.14 |
| Rate for Payer: Aetna Commercial |
$1,553.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,406.00
|
| Rate for Payer: Aetna Managed Medicare |
$141.98
|
| Rate for Payer: Anthem Medicare Advantage |
$141.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.98
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna Commercial |
$1,553.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.98
|
| Rate for Payer: Health EOS Commercial |
$1,487.74
|
| Rate for Payer: HFN Commercial |
$1,553.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$511.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.98
|
| Rate for Payer: Multiplan Commercial |
$1,307.90
|
| Rate for Payer: NAPHCARE Commercial |
$212.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,553.14
|
| Rate for Payer: Quartz Beloit One Network |
$719.35
|
| Rate for Payer: Quartz Commercial |
$931.88
|
| Rate for Payer: Quartz Medicare Advantage |
$141.98
|
| Rate for Payer: The Alliance Commercial |
$354.95
|
| Rate for Payer: United Healthcare Medicaid |
$111.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.98
|
| Rate for Payer: WEA Trust Commercial |
$899.18
|
| Rate for Payer: WPS Commercial |
$567.92
|
|
|
Motor&/sens 5-6 nrv cndj tst 9590926
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
CPT 95909 26
|
| Hospital Charge Code |
3127529
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$631.33 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$80.64
|
| Rate for Payer: Anthem Medicare Advantage |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.64
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$631.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.64
|
| Rate for Payer: Health EOS Commercial |
$604.75
|
| Rate for Payer: HFN Commercial |
$631.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$120.96
|
| Rate for Payer: Preferred Network Access Commercial |
$631.33
|
| Rate for Payer: Quartz Beloit One Network |
$292.41
|
| Rate for Payer: Quartz Commercial |
$378.80
|
| Rate for Payer: Quartz Medicare Advantage |
$80.64
|
| Rate for Payer: The Alliance Commercial |
$201.60
|
| Rate for Payer: United Healthcare Medicaid |
$62.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.64
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$322.57
|
|
|
Motor&/sens 7-8 nrv cndj tst 95910
|
Professional
|
Both
|
$2,373.00
|
|
|
Service Code
|
CPT 95910
|
| Hospital Charge Code |
3147572
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$2,344.52 |
| Rate for Payer: Aetna Commercial |
$2,344.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,122.41
|
| Rate for Payer: Aetna Managed Medicare |
$185.07
|
| Rate for Payer: Anthem Medicare Advantage |
$185.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.07
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cigna Commercial |
$2,344.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.07
|
| Rate for Payer: Health EOS Commercial |
$2,245.81
|
| Rate for Payer: HFN Commercial |
$2,344.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.07
|
| Rate for Payer: Multiplan Commercial |
$1,974.34
|
| Rate for Payer: NAPHCARE Commercial |
$277.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.88
|
| Rate for Payer: Quartz Commercial |
$1,406.71
|
| Rate for Payer: Quartz Medicare Advantage |
$185.07
|
| Rate for Payer: The Alliance Commercial |
$462.67
|
| Rate for Payer: United Healthcare Medicaid |
$147.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.07
|
| Rate for Payer: WEA Trust Commercial |
$1,357.36
|
| Rate for Payer: WPS Commercial |
$740.27
|
|
|
Motor&/sens 7-8 nrv cndj tst 9591026
|
Professional
|
Both
|
$2,373.00
|
|
|
Service Code
|
CPT 95910 26
|
| Hospital Charge Code |
3571509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$2,344.52 |
| Rate for Payer: Aetna Commercial |
$2,344.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,122.41
|
| Rate for Payer: Aetna Managed Medicare |
$107.09
|
| Rate for Payer: Anthem Medicare Advantage |
$107.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.09
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cash Price |
$711.90
|
| Rate for Payer: Cigna Commercial |
$2,344.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Health EOS Commercial |
$2,245.81
|
| Rate for Payer: HFN Commercial |
$2,344.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$382.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.09
|
| Rate for Payer: Multiplan Commercial |
$1,974.34
|
| Rate for Payer: NAPHCARE Commercial |
$160.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,085.88
|
| Rate for Payer: Quartz Commercial |
$1,406.71
|
| Rate for Payer: Quartz Medicare Advantage |
$107.09
|
| Rate for Payer: The Alliance Commercial |
$267.72
|
| Rate for Payer: United Healthcare Medicaid |
$83.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.09
|
| Rate for Payer: WEA Trust Commercial |
$1,357.36
|
| Rate for Payer: WPS Commercial |
$428.36
|
|
|
Motor&/sens 9-10 nrv cndj test 95911
|
Professional
|
Both
|
$2,784.00
|
|
|
Service Code
|
CPT 95911
|
| Hospital Charge Code |
3165562
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.95 |
| Max. Negotiated Rate |
$2,750.59 |
| Rate for Payer: Aetna Commercial |
$2,750.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,490.01
|
| Rate for Payer: Aetna Managed Medicare |
$220.60
|
| Rate for Payer: Anthem Medicare Advantage |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$220.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$220.60
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cigna Commercial |
$2,750.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.60
|
| Rate for Payer: Health EOS Commercial |
$2,634.78
|
| Rate for Payer: HFN Commercial |
$2,750.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$807.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$220.60
|
| Rate for Payer: Multiplan Commercial |
$2,316.29
|
| Rate for Payer: NAPHCARE Commercial |
$330.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.96
|
| Rate for Payer: Quartz Commercial |
$1,650.36
|
| Rate for Payer: Quartz Medicare Advantage |
$220.60
|
| Rate for Payer: The Alliance Commercial |
$551.51
|
| Rate for Payer: United Healthcare Medicaid |
$177.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.60
|
| Rate for Payer: WEA Trust Commercial |
$1,592.45
|
| Rate for Payer: WPS Commercial |
$882.42
|
|
|
Motor&/sens 9-10 nrv cndj test 9591126
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 95911 26
|
| Hospital Charge Code |
3245494
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.41 |
| Max. Negotiated Rate |
$1,115.45 |
| Rate for Payer: Aetna Commercial |
$1,115.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$133.64
|
| Rate for Payer: Anthem Medicare Advantage |
$133.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.64
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,115.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.64
|
| Rate for Payer: Health EOS Commercial |
$1,068.49
|
| Rate for Payer: HFN Commercial |
$1,115.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.64
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$200.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.45
|
| Rate for Payer: Quartz Beloit One Network |
$516.63
|
| Rate for Payer: Quartz Commercial |
$669.27
|
| Rate for Payer: Quartz Medicare Advantage |
$133.64
|
| Rate for Payer: The Alliance Commercial |
$334.10
|
| Rate for Payer: United Healthcare Medicaid |
$104.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.64
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$534.56
|
|
|
MOUTHPIECE ACAPELLA DH BLUE
|
Facility
|
OP
|
$936.00
|
|
| Hospital Charge Code |
2973630
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$272.56 |
| Max. Negotiated Rate |
$895.56 |
| Rate for Payer: Aetna Commercial |
$876.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.16
|
| Rate for Payer: Aetna Managed Medicare |
$272.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$632.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$467.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.92
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$895.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$544.75
|
| Rate for Payer: Health EOS Commercial |
$866.36
|
| Rate for Payer: HFN Commercial |
$895.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$730.08
|
| Rate for Payer: Multiplan Commercial |
$778.75
|
| Rate for Payer: NAPHCARE Commercial |
$584.06
|
| Rate for Payer: Preferred Network Access Commercial |
$895.56
|
| Rate for Payer: Quartz Beloit One Network |
$476.99
|
| Rate for Payer: Quartz Commercial |
$632.74
|
| Rate for Payer: Quartz Medicare Advantage |
$584.06
|
| Rate for Payer: The Alliance Commercial |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$535.39
|
| Rate for Payer: WPS Commercial |
$721.00
|
|
|
MOUTHPIECE ACAPELLA DH BLUE
|
Facility
|
IP
|
$936.00
|
|
| Hospital Charge Code |
2973630
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$476.99 |
| Max. Negotiated Rate |
$895.56 |
| Rate for Payer: Aetna Commercial |
$876.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.92
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$895.56
|
| Rate for Payer: Health EOS Commercial |
$866.36
|
| Rate for Payer: HFN Commercial |
$895.56
|
| Rate for Payer: Multiplan Commercial |
$778.75
|
| Rate for Payer: Preferred Network Access Commercial |
$895.56
|
| Rate for Payer: Quartz Beloit One Network |
$476.99
|
| Rate for Payer: Quartz Commercial |
$584.06
|
| Rate for Payer: WEA Trust Commercial |
$535.39
|
| Rate for Payer: WPS Commercial |
$721.00
|
|
|
MOUTHPIECE ACAPELLA DH GREEN FLUTTER
|
Facility
|
OP
|
$947.00
|
|
| Hospital Charge Code |
2973614
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$906.09 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Aetna Managed Medicare |
$275.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$492.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$551.15
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$738.66
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: NAPHCARE Commercial |
$590.93
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$640.17
|
| Rate for Payer: Quartz Medicare Advantage |
$590.93
|
| Rate for Payer: The Alliance Commercial |
$492.44
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
MOUTHPIECE ACAPELLA DH GREEN FLUTTER
|
Facility
|
IP
|
$947.00
|
|
| Hospital Charge Code |
2973614
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$482.59 |
| Max. Negotiated Rate |
$906.09 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$590.93
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
MOUTHPIECE ENDOSCOPIC SNGL USE
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
2973196
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
