|
ARM SLING SMALL TX990203
|
Facility
IP
|
$109.00
|
|
| Hospital Charge Code |
2974221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
ARM SLING SMALL TX990203
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
2974221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$65.40
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
ARM SLING (TX990206) XLARGE
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974224
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$30.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ARM SLING (TX990206) XLARGE
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974224
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ARM UNIT TRIBUTE #UE-CG
|
Facility
IP
|
$5,035.00
|
|
| Hospital Charge Code |
2973640
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,467.15 |
| Max. Negotiated Rate |
$4,632.20 |
| Rate for Payer: Aetna Commercial |
$4,531.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,668.55
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$4,632.20
|
| Rate for Payer: Health EOS Commercial |
$4,481.15
|
| Rate for Payer: HFN Commercial |
$4,632.20
|
| Rate for Payer: Multiplan Commercial |
$4,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,021.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,632.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,467.15
|
| Rate for Payer: Quartz Commercial |
$3,021.00
|
| Rate for Payer: WEA Trust Commercial |
$2,769.25
|
| Rate for Payer: WPS Commercial |
$3,729.42
|
|
|
ARM UNIT TRIBUTE #UE-CG
|
Facility
OP
|
$5,035.00
|
|
| Hospital Charge Code |
2973640
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,409.80 |
| Max. Negotiated Rate |
$20,140.00 |
| Rate for Payer: Aetna Commercial |
$4,531.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,330.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,409.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,272.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,517.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,416.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,668.55
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$4,632.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,817.59
|
| Rate for Payer: Health EOS Commercial |
$4,481.15
|
| Rate for Payer: HFN Commercial |
$4,632.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,776.25
|
| Rate for Payer: Multiplan Commercial |
$4,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,021.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,632.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,467.15
|
| Rate for Payer: Quartz Commercial |
$3,272.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,021.00
|
| Rate for Payer: The Alliance Commercial |
$20,140.00
|
| Rate for Payer: WEA Trust Commercial |
$2,769.25
|
| Rate for Payer: WPS Commercial |
$3,729.42
|
|
|
ARM WRAP MCCONNELL 12401
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
HCPCS A6449
|
| Hospital Charge Code |
2965285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.50
|
| Rate for Payer: Aetna Managed Medicare |
$245.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.75
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$805.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.65
|
| Rate for Payer: Health EOS Commercial |
$778.75
|
| Rate for Payer: HFN Commercial |
$805.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$656.25
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: NAPHCARE Commercial |
$525.00
|
| Rate for Payer: Preferred Network Access Commercial |
$805.00
|
| Rate for Payer: Quartz Beloit One Network |
$428.75
|
| Rate for Payer: Quartz Commercial |
$568.75
|
| Rate for Payer: Quartz Medicare Advantage |
$525.00
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
|
ARM WRAP MCCONNELL 12401
|
Facility
IP
|
$875.00
|
|
|
Service Code
|
HCPCS A6449
|
| Hospital Charge Code |
2965285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.75 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.75
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$805.00
|
| Rate for Payer: Health EOS Commercial |
$778.75
|
| Rate for Payer: HFN Commercial |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: NAPHCARE Commercial |
$525.00
|
| Rate for Payer: Preferred Network Access Commercial |
$805.00
|
| Rate for Payer: Quartz Beloit One Network |
$428.75
|
| Rate for Payer: Quartz Commercial |
$525.00
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
|
Arrow Sure Shot Epidural Ndle
|
Facility
OP
|
$120.00
|
|
| Hospital Charge Code |
3101766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: The Alliance Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Arrow Sure Shot Epidural Ndle
|
Facility
IP
|
$120.00
|
|
| Hospital Charge Code |
3101766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Arsenic Level
|
Facility
OP
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Managed Health Services Medicaid |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$28.46
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.60
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare PPO |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: Wellcare Medicare |
$18.97
|
| Rate for Payer: WMAP Medicaid |
$19.60
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Arsenic Level
|
Facility
IP
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
Arsenic Level
|
Professional
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$342.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$327.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$342.00
|
| Rate for Payer: Quartz Beloit One Network |
$158.40
|
| Rate for Payer: Quartz Commercial |
$205.20
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$83.47
|
|
|
Arsenic Level 24 Hr Urine
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Arsenic Level 24 Hr Urine
|
Professional
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$83.47
|
|
|
Arsenic Level 24 Hr Urine
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Managed Health Services Medicaid |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$28.46
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.60
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$18.97
|
| Rate for Payer: WMAP Medicaid |
$19.60
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Arsenic Level, Hair
|
Professional
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$83.47
|
|
|
Arsenic Level, Hair
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Managed Health Services Medicaid |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$28.46
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.60
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare PPO |
$262.50
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: Wellcare Medicare |
$18.97
|
| Rate for Payer: WMAP Medicaid |
$19.60
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Arsenic Level, Hair
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Arsenic Level, Nails
|
Professional
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$380.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$364.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Preferred Network Access Commercial |
$380.00
|
| Rate for Payer: Quartz Beloit One Network |
$176.00
|
| Rate for Payer: Quartz Commercial |
$228.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$83.47
|
|
|
Arsenic Level, Nails
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$360.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$356.00
|
| Rate for Payer: HFN Commercial |
$368.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Managed Health Services Medicaid |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: NAPHCARE Commercial |
$28.46
|
| Rate for Payer: Preferred Network Access Commercial |
$368.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.60
|
| Rate for Payer: Quartz Beloit One Network |
$196.00
|
| Rate for Payer: Quartz Commercial |
$260.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$1,600.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare PPO |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: Wellcare Medicare |
$18.97
|
| Rate for Payer: WMAP Medicaid |
$19.60
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
|
Arsenic Level, Nails
|
Facility
IP
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$360.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$368.00
|
| Rate for Payer: Health EOS Commercial |
$356.00
|
| Rate for Payer: HFN Commercial |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: NAPHCARE Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$368.00
|
| Rate for Payer: Quartz Beloit One Network |
$196.00
|
| Rate for Payer: Quartz Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| Rate for Payer: WPS Commercial |
$296.28
|
|
|
Art Bld Gas CABG
|
Facility
IP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Art Bld Gas CABG
|
Facility
OP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.91 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.76
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$78.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicaid |
$39.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Managed Health Services Medicaid |
$41.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$78.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.16
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.91
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$2,152.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: United Healthcare PPO |
$403.50
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$78.77
|
| Rate for Payer: WMAP Medicaid |
$39.91
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Art Bld Gas CABG
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.77 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.77
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$311.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$346.59
|
|
