|
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: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| 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
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$331.20 |
| 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 DHI/DHP/ASO |
$201.46
|
| 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 |
$75.88
|
| 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
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| 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 |
$216.00
|
| Rate for Payer: Health EOS Commercial |
$327.60
|
| Rate for Payer: HFN Commercial |
$342.00
|
| 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: 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: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| 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
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$93.84 |
| 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 DHI/DHP/ASO |
$57.08
|
| 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 |
$75.88
|
| 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 24 Hr Urine
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| 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 |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| 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: 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: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Arsenic Level, Hair
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| 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 |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| 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: 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: The Alliance Commercial |
$175.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
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 |
$322.00 |
| 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 DHI/DHP/ASO |
$195.86
|
| 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 |
$75.88
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| 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
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| 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 |
$240.00
|
| Rate for Payer: Health EOS Commercial |
$364.00
|
| Rate for Payer: HFN Commercial |
$380.00
|
| 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: 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: The Alliance Commercial |
$200.00
|
| Rate for Payer: WEA Trust Commercial |
$220.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$344.00
|
| 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
|
|
|
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 |
$368.00 |
| 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 DHI/DHP/ASO |
$223.84
|
| 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 |
$75.88
|
| 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
|
|
|
Art Bld Gas CABG
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.72 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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 |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| 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: 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: The Alliance Commercial |
$269.00
|
| 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 |
$494.96 |
| 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 DHI/DHP/ASO |
$301.06
|
| 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 |
$315.08
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| 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
|
|
|
Arterial Coiling Not Hemorrhage or Tumor
|
Facility
|
OP
|
$18,437.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
4597126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,034.13 |
| Max. Negotiated Rate |
$69,327.32 |
| Rate for Payer: Aetna Commercial |
$16,593.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,855.82
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,771.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$5,531.10
|
| Rate for Payer: Cash Price |
$5,531.10
|
| Rate for Payer: Cash Price |
$5,531.10
|
| Rate for Payer: Cigna Commercial |
$16,962.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$16,408.93
|
| Rate for Payer: HFN Commercial |
$16,962.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$14,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$16,962.04
|
| Rate for Payer: Quartz Beloit One Network |
$9,034.13
|
| Rate for Payer: Quartz Commercial |
$11,984.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$69,327.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$10,140.35
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$13,656.29
|
|
|
Arterial Coiling Not Hemorrhage or Tumor
|
Facility
|
IP
|
$18,437.00
|
|
|
Service Code
|
CPT 37242
|
| Hospital Charge Code |
4597126
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,034.13 |
| Max. Negotiated Rate |
$16,962.04 |
| Rate for Payer: Aetna Commercial |
$16,593.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,855.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,771.61
|
| Rate for Payer: Cash Price |
$5,531.10
|
| Rate for Payer: Cigna Commercial |
$16,962.04
|
| Rate for Payer: Health EOS Commercial |
$16,408.93
|
| Rate for Payer: HFN Commercial |
$16,962.04
|
| Rate for Payer: Multiplan Commercial |
$14,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,062.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,962.04
|
| Rate for Payer: Quartz Beloit One Network |
$9,034.13
|
| Rate for Payer: Quartz Commercial |
$11,062.20
|
| Rate for Payer: WEA Trust Commercial |
$10,140.35
|
| Rate for Payer: WPS Commercial |
$13,656.29
|
|
|
ARTERIAL LINE PLACEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ARTERIAL LINE PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Arterial Monit 3-6 Hrs
|
Facility
|
OP
|
$2,407.00
|
|
| Hospital Charge Code |
3101754
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$673.96 |
| Max. Negotiated Rate |
$9,628.00 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Aetna Managed Medicare |
$673.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,564.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,155.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,346.96
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,805.25
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,564.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,444.20
|
| Rate for Payer: The Alliance Commercial |
$9,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
|
Arterial Monit 3-6 Hrs
|
Facility
|
IP
|
$2,407.00
|
|
| Hospital Charge Code |
3101754
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,179.43 |
| Max. Negotiated Rate |
$2,214.44 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,444.20
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
|
Arterial Monitor Over 6 Hrs
|
Facility
|
IP
|
$3,566.00
|
|
| Hospital Charge Code |
3101755
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,747.34 |
| Max. Negotiated Rate |
$3,280.72 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,066.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,139.60
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
Arterial Monitor Over 6 Hrs
|
Facility
|
OP
|
$3,566.00
|
|
| Hospital Charge Code |
3101755
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$998.48 |
| Max. Negotiated Rate |
$14,264.00 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,066.76
|
| Rate for Payer: Aetna Managed Medicare |
$998.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,317.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,783.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,711.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,995.53
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,317.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,139.60
|
| Rate for Payer: The Alliance Commercial |
$14,264.00
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
Arterial Monit To 3Hrs
|
Facility
|
OP
|
$1,539.00
|
|
| Hospital Charge Code |
3101753
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
Arterial Monit To 3Hrs
|
Facility
|
IP
|
$1,539.00
|
|
| Hospital Charge Code |
3101753
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
