|
PYLOROPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
PYLOROPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Pyruvate
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$15.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.00
|
| Rate for Payer: Anthem Medicare Advantage |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.06
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.06
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$22.59
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$15.06
|
| Rate for Payer: The Alliance Commercial |
$60.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.06
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: Wellcare Medicare |
$15.06
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Pyruvate
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Pyruvate
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$15.06
|
| Rate for Payer: Anthem Medicare Advantage |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.06
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.06
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$22.59
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$15.06
|
| Rate for Payer: The Alliance Commercial |
$59.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$66.26
|
|
|
Pyruvic Acid
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
Pyruvic Acid
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$66.26 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$15.06
|
| Rate for Payer: Anthem Medicare Advantage |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.06
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.06
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$22.59
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.06
|
| Rate for Payer: The Alliance Commercial |
$59.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$66.26
|
|
|
Pyruvic Acid
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$15.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.00
|
| Rate for Payer: Anthem Medicare Advantage |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.06
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.06
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$22.59
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$15.06
|
| Rate for Payer: The Alliance Commercial |
$60.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.06
|
| Rate for Payer: United Healthcare PPO |
$49.14
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: Wellcare Medicare |
$15.06
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
Q Fever Ab (IgG, IgM)
|
Facility
|
OP
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$59.01
|
| Rate for Payer: HFN Commercial |
$61.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$53.04
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$61.00
|
| Rate for Payer: Quartz Beloit One Network |
$32.49
|
| Rate for Payer: Quartz Commercial |
$43.09
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$50.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare PPO |
$49.73
|
| Rate for Payer: WEA Trust Commercial |
$36.47
|
| Rate for Payer: Wellcare Medicare |
$12.60
|
| Rate for Payer: WPS Commercial |
$49.11
|
|
|
Q Fever Ab (IgG, IgM)
|
Professional
|
Both
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$62.98 |
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$62.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$60.33
|
| Rate for Payer: HFN Commercial |
$62.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$53.04
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$62.98
|
| Rate for Payer: Quartz Beloit One Network |
$29.17
|
| Rate for Payer: Quartz Commercial |
$37.79
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$49.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$36.47
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Q Fever Ab (IgG, IgM)
|
Facility
|
IP
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.14
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$61.00
|
| Rate for Payer: Health EOS Commercial |
$59.01
|
| Rate for Payer: HFN Commercial |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$61.00
|
| Rate for Payer: Quartz Beloit One Network |
$32.49
|
| Rate for Payer: Quartz Commercial |
$39.78
|
| Rate for Payer: WEA Trust Commercial |
$36.47
|
| Rate for Payer: WPS Commercial |
$49.11
|
|
|
Q Fever Ab IgG phase II
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$55.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$49.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Q Fever Ab IgG phase II
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Q Fever Ab IgG phase II
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$50.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare PPO |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: Wellcare Medicare |
$12.60
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Q Fever Ab IgM Phase I
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$55.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$49.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Q Fever Ab IgM Phase I
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Q Fever Ab IgM Phase I
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$50.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare PPO |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: Wellcare Medicare |
$12.60
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Q Fever Ab IgM Phase II
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Q Fever Ab IgM Phase II
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$55.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$49.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Q Fever Ab IgM Phase II
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$50.42 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$18.91
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$50.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare PPO |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: Wellcare Medicare |
$12.60
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
QUADRICEPS TENDON REPAIR, RUPTURED
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2960537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.37 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,430.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,320.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,554.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,452.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,858.78
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,831.36
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,065.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,320.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,065.09
|
| Rate for Payer: The Alliance Commercial |
$2,554.24
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
QUADRICEPS TENDON REPAIR, RUPTURED
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2960537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,503.16 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,065.09
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
Quad Screen
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Quad Screen
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$68.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$76.74
|
|
|
Quad Screen
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.95
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$69.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$17.44
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
